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Full text of "The Hydropathic encyclopedia [electronic resource]: a system of hydropathy and hygiene"

,-- ^riV^* 



THE 

ABNER WELLBORN CALHOUN 

MEDICAL LIBRARY 

1923 




^ 



PRESENTED BY 






•^p 



THE 



HYDROPATHIC ENCYCLOPEDIA: 



A SYSTEM 07 



HYDROPATHY AND HYGIENE. 



; ti (Eigjtt ^arts: 



I. OUTLINE OF ANATOMY, ILLUSTRATED. 
II. PHYSIOLOGY OF THE HUMAN BODY. 

III. HYGIENIC AGENCIES, AND THE PRES- 

F.RVATION OF HEALTH. 

IV. DIETETIC AND HYDROrATHIC COOKERY. 
y. THEORY AND PRACTICE OF WATER- 
TREATMENT. 



VI. SPECIAL PATHOLOGY AND HYDRO-THE- 
RAPEUTICS, INCLUDING THE NATURE, 
CAUSES, SYMPTOMS, AND TREATMENT 
OF ALL KNOWN DISEASES'. 
VII. APPLICATION Tr> SURGICAL DISEASES. 
VIII. APPLICATION OF HYDROPATHY TO MID- 
WIFERY AND THE NURSERY. 



LESIGNED AS 

A GUIDE TO FAMILIES AND STUDENTS. 

AND A TEXT -BOOK FOR PHYSICIANS. 

BY R. T. TRALL, M.D. 

SUSftl) Numerous fanatabeti Kllusttatfons. 
VOLUME II. 



NEW YOEK: 
FOWLERS AND WELLS, PUBLISHERS, 

CLINTON HAM,, 131 NASSAU STRKKT. 
18 53- 






Entered, according to act Df Congress, in the year 1851, by 
FOWLERS AND WELLS, 

In the Clerk's Office of the District Court of the United States for the Southern District 
of New York. 



HYDROPATHIC ENCYCLOPEDIA 



PART V. 

THEORY AND PRACTICE. 



CHAPTER I. 

PHILOSOPHY OF WATER-CURE. 

Rklations of Watkk to the Hkalthy Okganism. — Before 
we can clearly comprehend the remedial relations of pure water to 
the morbid conditions of the body, we must understand its physiological 
or vital relations to the healthy organism. These may be stated most 
succinctly, and remembered most easily, in the form of distinct prop- 
ositions. 

1. Water constitutes the greater proportion of the entire bulk of the 
body. 

2. Water composes more than three fourths of the whole mass of 
blood; more than seven eighths of the substance of the brain, and 
more than nine tenths of the various colorless fluids and secretions. 

3. Water is the only vehicle by which nutrient matters arc conveyed 
to the blood, and through the blood to all parts of the system for its 
growth and replenishment. 

4. Water is the only medium through which waste or effete parti 
cles, or extraneous ingredients, are conveyed from all parts of the sys 
tern to the excretory organs to be expelled. 

5. Water is the only solvent, diluent, and detergent in existence, for 
animal and vegetable alimentary and excrementitious matters. 

(i. Water is the only material capable of circulating in all the tissues 
of the body, and penetrating their finest vessels, without vital irritat.&u 
or mechanical injury. 

7. The only morbid effects of water result from improper tempeia- 



THEORV AND PRACTICE. 



ture, and over-distension of the hollow viscera, or circulating vessels, 
from excess of quantity — effects never necessarily unavoidable. 

Modus Operandi of Water. — Contrary to the teachings of the 
standard medical books of allopathic, homeopathic, and eclectic schco.s, 
we must ever bear in mind that disease is never a positive entity, but 
always a negative quality ; it is the absence of health, or of the state, 
circumstances, and actions which constitute that balance of functional 
duty we call health. By referring to the misuse or abuse of some one 
or more of the hygienic agencies, we find the cause or causes of those 
deviations from the normal state, which constitute the abnormal state, 
and which we call disease ; and now, by applying the above propositions 
to the causes which produce and the conditions which constitute dis- 
ease, we will find the true grounds which indicate and demonstrate 
water to be a remedy of general, and even universal application. 

In a general sense, diseases are produced by bad air, improper light, 
impure food and drink, excessive or defective alimentation, indolence 
or over-exertion, unregulated passions, in three words — unphysiological 
voluntary habits. The conditions of the body in disease — the proximate 
causes against which all remedial efforts are to be directed — are, in 
general terms, impure blood, unhealthy secretions, obstructions in the 
minute vascular structures, or capillary vessels, excessive action in some 
parts or organs, with deficient action in others, unequal temperature, 
etc., in other words, a loss of balance in the circulation and action of 
the various parts of the vital machinery, producing great discord in some 
portion of it, and more or less disorder in all. The general indications 
are, therefore, to remove obstructions, wash away impurities, supply 
healthful nutriment, regulate temperature, relax intensive and intensify 
torpid action, etc. ; and what like water, what but water, with its concom- 
itants, air, light, food, temperature, etc., can answer to these indications? 

To say that medicinal drugs can answer these indications is sheer 
nonsense. They may respond to any other indications almost that can 
be named; but these, never. They may change the issue, they may 
suppress a symptom, remove a pain, transfer an irritation, excite a 
new vital resistance, produce another obstruction, and so divide the or- 
ganic struggle between two points, diminish vital power, or increase 
vital expenditure ; but none of these impressions or effects are really 
remedial, none of them meet the indications ; and if physicians in gen- 
eral, and mankind in particular, are not satisfied with the experiments 
of three thousand years, which, by the way, have destroyed ten times 
as many of the human family as they have saved, let them by all 
means be satisfied, even if they have to go on in the same absurd, 



PHILOSOPHY OF AVATER-CURE. 



blundering, and senseless, though very learned and scientific business, 
of drugging and killing, marring and scarring, for three thousand years 
longer. 

Water, according to the mode of application, can intensify or mod- 
erate any function; it can energize or abate any given action; it can be 
made to increase or diminish temperature, locally or generally, to any 
extent desired; hence, though not a universal cure — for diseases are not 
universally curable — it is a remedy universally applicable. But while 
water, judiciously managed, may be doing its appropriate work in alle- 
viating or curing disease, other causes may counteract, retard, or en- 
tirely prevent the consummation of any curative process. The patient 
may live badly in other respects ; something in his eating, or drinking, 
or sleeping, or exercising, or other voluntary habits, may be wrong, and 
constantly re-supply the causes of disease as fast or faster than the 
best remedial use of water can remove or overcome them; therefore, 
though water is put prominently forward in the hydropathic system 
as in all cases the great 'panacea, it must ever be recollected that it is 
but one of several remedial agencies whose influence is equally to be 
regarded in preserving health or in curing diseases. 

To illustrate : Of fifty or a hundred invalids at a hydropathic in- 
stitution, while all may employ water in the way of bathing in the 
best jwssible manner, one half of them will pretty certainly hold on to 
some unhealthful habit which retards or prevents the cure, or renders 
it imperfect. Ono will nibble on candies or fruits between meals ; 
some in the cities will lunch on oysters or plum-pudding; some will 
eat flesh immoderately : others will persist in the use of butter or 
greasy meats sufficiently to keep them constantly bilious ; others will 
take salt enough to keep the whole body pickled, as it. were, in an 
acrid brine; others will eat an undue proportion of fine flour, and keep 
the bowels all the while constipated ; others will endeavor to make up 
by the "stimulus of distension" for the lack of mustard, vinegar, and 
pepper ; others will drink tea or coffee, chew tobacco, or smoke cigars 
occasionally; and yet others will indulge in a dose or two of drugs now 
and then, stealthily, of course ; and so on to the end of the chapter of 
"errors in Water-Cure. " It is true all these things are ruled out of 
the establishments, but they are, notwithstanding, very frequently 
practiced by many patients; and what is particularly vexatious, ungrate- 
ful, and perverse, all the evil consequences of their bad habit are usually 
imputed to the Water-Cure! 

It may be said that the physician ought to manage all these matters, 
and make all patients conform in all respects to a physiological regimen. 
Tlii.s is not always possible, for with many invalids habit is much 



THEORY AND PRACTICE. 



stronger than reason, nnd with some dyspeptics tLs craving of the 
morbid appetite for its disease-producing aliments, and condiments, 
and narcotics, is not a whit more governable than is the drunkard's 
appetite for those intoxicating poisons which have produced his insa- 
tiate craving. Both kinds of appetite are controlled, and finally over- 
come by a few ; but sad experience tells the story that the majority 
are conquered and destroyed by them. 

In accounting for the therapeutic operation of particular processes 
of the water-treatment, we must never forget that Nature is the true 
physician. The restorative power is inherent in the living organism. 
All that the true healing art can do is to supply favorable conditions, 
remove extraneous materials, and regulate hygienic influences, and 
thus place the system as fully as possible under organic law. 

The humoral pathologists impute all diseases to a lentor, or morbific 
matter in the blood ; while the solidists and vitalists contend that the 
action of the solids — being too much increased or diminished — is the 
proximate cause of all diseases. The former bleed, leech, scarify, 
blister, sweat, puke, purge, stimulate, and antiphlogistieate ; and the 
latter bleed, leech, scarify, blister, sweat, puke, purge, stimulate, and 
antiphlogistieate too ! Here is diversity of cause producing identity of 
effect ; a postulate not dreamed of in natural philosophy. 

We may apply water to the treatment of disease, on either theory, 
much more rationally than the allopath can his drugs and depletives. 
"Whichever theory we adopt — and both are correct to a certain extent— 
we can alter, depurate, change, increase, restrain, or modify the fluids 
and actions with water aud regimen, as well as with lancets and drugs, 
and with none of their necessary evils or ever-present dangers. We 
can even get minerals, chemicals, and other drug-medicines out of the 
body by means of water-treatment, whereas the ne plus ultra of drug 
medical science consists in getting the system full of them, and then 
abandoning it to its fate, and '-the efforts of nature." 

It is no uncommon circumstance for patients to become severely 
salivated during water-treatment. I have treated several cases wherein 
patients who had taken no mercury for several years, experienced all 
the symptoms of a "mercurial course," such as tender, fleecy gums, 
metallic taste, fetid breath, swelled tongue, and copious droolling. Other 
mineral poisons also produce great constitutional or local disturbance 
during the process by which they are expelled from l be body. These 
drugs, ns already intimated, all the other drugs in creation have no 
power to remove from the body. They may, like acids and alkalies, 
silence each other's specific action, or combine to produce a different 
action ; but they do not and cannot drive each other out of the system. 



PHILOSOPHY OF WATER-CURE. 



The manner in which water purifies the body from mercury and 
other mineral poisons, alias medicines, affords an explanation of its 
mode of action in a great variety of morbid conditions. Referring to 
the laws of endosmose and exosmose, as explained in the physiological 
part of this work, we find that when animal membranes, living or 
dead, and whether connected to or separated from the body, have 
their opposite surfaces in contact with dissimilar iluids, an interchange 
takes place, which is continued until the constituents of both fluids 
become exactly similar, when all action between them ceases. Dr; E. 
Johnson (Domestic Hydropathy) has constructed the following dia- 
grams, which very well illustrate this subject: 



Fig. 162. 



In fig. 162 a is a glass tube, the di- 
ameter of whoso caliber is four tenths 
of an inch. Close one of its ends ac- 
curately with a piece of bladder, and 
fil! the tube with brine. Now take a 
much larger tube (o) — a common tum- 
bler will do — and fill it three quarters 
full with pure water. Then immerse 
the bladder-end of the small tube just 
under the surface of the water of the 
larger tube or tumbler, giving it an in- 
clination of about 45°. In a short time 
a current of liquid will be seen rising 
from the bottom of the water in the 
tumbler, upward along its side, in the 
direction indicated by the arrows, 
through the bladder, and up along one 
side of the small tube to the surface of 
the brine; then it descends along the endosmose and exosmose. 
other side of the small tube, in the direction of the arrows on that 
side, down through the brine, and through the bladder^, down to the 
bottom of the water. The downward current is a current of brine 
descending into the water in the tumbler. The upward current is a 
current of pure water ascending into the tube to supply the place of 
the lost brine ; and this current will continue until the two fluids have 
become similar, that is, until the fluid in the basin has become as salt 
as that contained in the tube. 

"If now the tumbler be emptied, and refilled with pure water, the 
current will be re-established, and in this way the brine in the tube 
may be completely purified of its salt. 

" The currents will be seen with beautiful distinctness if some very 




THEORV AND PRACTICE. 



ENDOS.MOJ'E and exosmose. 



fine particles of indigo be suspended in both fluids — that in the tum- 
bler, and that in the lube. 

w im "If the tube a, in fig. 163, which 

contains the brine, have a caliber whose 
diametei is four fifths of an inch, and 
if it be supported vertically, so that the 
bladder-end be immersed just below 
the surface of the water in the tumbler 
(&), two currents will be seen to ascend, 
in the direction of the arrows, through 
the bladder, one on either side of the 
tube, to near the surface of the brine. 
They now turn, and descend together 
in a double current through the middle 
of the brine in the tube, down through 
the bladder into the water, where they 
diverge, turn again, and again ascend. 
The double current descending through 
the middle of the tube is a current of 
brine coming down into the water in 
the tumbler. The two separate outer 
currents ascending from near the bottom of the water in the tumbler, 
are two currents of water going up through the bladder into the tube, 
to supply the place of the brine which has descended into the water. 

" Now when pure water is held in contact with the external surface 
of the skin of the body, by means of the wet sheet, or any other 
means, precisely the same conditions are established with regard to the 
fluids within the body, that is, on the inside of the skin, and the water 
which is in contact with its outer surface, as are established in fig. 163, 
between the fluid (brine) contained in the tube, that is, on the inside 
of the bladder, and the water in the tumbler, which is in contact with 
the bladder's outer surface. About eighty per cent, of the blood is 
water, and it is this water which holds in solution whatever soluble 
substances, whether poisonous or otherwise, happen to be present in 
the blood ; and it is this water, holding in solution fibrin, albumen, and 
the various salts proper to the blood, which alone circulates in those 
myriads- of millions of millions of capillary vessels which are too small 
to admit the red particles. When any poisonous matters are present 
in the blood, it is in this water of the blood that they are held "in solu- 
tion, as t!>e salt is held in solution in the water of the brine. 

" Nov/ when by means of the wet sheet, pure water is held in con- 
tact with the outer surface of the si in, and supposing that the water 



PHILOSOPHY OF WATER-CURE. 9 

of the blood, which is on the inside of it, is poise tied, say with bichloride 
of mercury, what happens is this: An interchange takes place between 
the fluid on the outside (pure water) and the fluid on the inside, viz., 
the water of the blood holding bichloride of mercury in solution. The 
mercury-and-water passes through the skin into the water of the wet 
sheet, while the pure w«ter of the wet sheet passes through the skin 
into the blood to supply the place of the mercury-and-water. As in 
figures 162 and 163, a double current is established ; a current of pure 
water into the body, and a current of mercury-and-water out of the 
body; and in this way, by frequently renewing the external contact 
of pure water with the skin, the blood is purified of whatever poisonous 
or otherwise morbid matters it may happen to contain. 

" If a glass tube be partially filled with a saturated solution of salt 
(brine), one end of the tube having been first carefully tied over with 
bladder, and if the tube be suspended in the air, in a short time that 
side of the bladder which is exposed to the air becomes covered with 
salt. The brine passes through the bladder from the inner to the 
outer surface. When it reaches the outer surface the water evaporates, 
leaving the salt adhering to the bladder. 

" When a person has taken the nitrate of silver for a considerable 
length of time, it is well known that the skin becomes colored perma- 
nently blue, from the lodgment of oxide of silver in the tissue of the 
skin, the nitrate being converted into a simple oxide. 

"It would seem that something similar happens here with regard to 
the salt of silver (nitrate of silver) and the skin, as happens with regard 
to the salt of the brine and the bladder, in the experiment just described 
above. The water of the blood, holding the nitrate of silver in solution, 
passes through the under layers of the skin until it reaches the rete 
mucosum, which lies immediately under the scar f -skin, not traveling 
along the perspiratory spiracles, but permeating the tissues. Having 
i-eached this locality, the water of the blood evaporates, while the sil- 
ver, unable to penetrate the dry and horny cuticle, is left fixed in the 
rete mucosum." 

Similar experiments may be tried, with similar results, with any of 
the soluble metallic, mineral, or earthy salts, as of arsenic, iodine, sul- 
phate of potassa, etc. I have known mercurial ulcers take place during 
water-treatment, on the lower extremities of patients whose bodies 
had, years previously, been thoroughly mercurialized, and which it 
was impossible to heal until after the body had become entirely cleansed 
of the mineral by several months' treatment. 

Water-Treatment and Drug Tpeatment Contrasted.— The 



10 THEORY AND PRACTICE 

above facts amply demonstrate the superiority as well as the more ra- 
tional philosophy of the water-treatment over the drug treatment on 
the humoral theory. But the vitalists have much to say about "dynamic 
forces." With them every thing goes by impression, or stimuli. Dis- 
ease is produced by morbid impressions on the brain, or nervous system, 
which impressions are conveyed to the various organs or parts of the 
body by nervous distribution, or functional sympathy; and remedies 
operate by electric, magnetic, stimulant, alterant, or some other force- 
ful property which makes impressions on the nervous centers, and 
these impressions are thence radiated through the system, and counter- 
act, overcome, subdue, or in some other most mysterious and utterly 
inexplicable manner, cure disease, or, perchance, by some unfortunate 
and unaccountable circumstance or accident, render it worse. 

But there is something of matter-of-fact in this theory, as, indeed, 
there is in nearly all the vagaries which have eve.r possessed men's 
minds. We know that mental impressions do disturb or modify, arrest 
or energize either and all of the functions of the body, and these im- 
pressions may be morbid or sanatory ; they may produce disease or 
remove it. But on this principle of physiological impressibility, is there 
not a better way of exciting counteracting morbid impressions than by 
drawing off the vital current, or poisoning the bodj through and 
through with pernicious drugs? Common sense replies in the affirm- 
ative, and all rational minds, unbiased by a miseducation, would 
respond, "there must be a better way." And here our "universal 
panacea," pure soft water, supplies the desideratum. On the theory 
of impressibility it is just what is desirable, and all that is requisite, if 
suitably aided by the other hygienic adjuvants. All the impressions 
made on the living body can only affect its functions aa they produce 
or arrest action or motion, which action or motion is muscular contrac 
tion. Cold water and ice are assuredly tVie most powerful constringing 
agents that can be applied to the living structures without destruction or 
injury, and hot water, or steam, is the most efficient relaxant that can 
be safely employed. For producing moderate contraction or relaxa- 
tion, we have all degrees of temperature between the freezing and 
the boiling points. 

The remedial effects of water, thus far considered, are a complete 
substitute for all the depletory processes of the regular system, as 
bleeding, leeching, antimonializing and refrigerating, and all the 
classes of medicines called emetics, cathartics, diaphoretics, diuretics, 
alteratives, tonics, and stimulants. But there are other classes which 
are called narcotics, nervines, and sedatives, to which opium, camphor, 
ether, musk, castor, henbane, ratsbane, djgsbane, wolfsbane, and divers 



PHILOSOPHY C«F WATER-CURE. 11 

other bares belong, which at first view seem more difficult to dispense 
with. There is something like a charm in the idea of sending down the 
the sick person's throat a dose which silences his pains and quiets his 
distress with magical celerity. But the charm is at once dispelled 
when we look to ultimate consequences. The very pain which the 
potent and ill-advised dose of the doctor has subdued is generally the 
warning voice of the organic instincts that something is wrong, or the 
effort of the organism to rid itself of an enemy. When the organic 
instincts proclaim to the whole domain of life, through the medium of 
the brain, that an enemy is present, that proclamation is felt, not heard, 
and its language is pain. It is one thing to silence the outcry of 
nature for help, but it is quite another thing to relieve her by dislodging 
the enemy. The first may often be done by narcotics and stimulants; 
the second can be accomplished by the use of water. In fact, water 
will often succeed in promptly removing pain which the most powerful 
narcotics fail to mitigate. There may be inflammation, obstruction, 
engorgement, distension or contraction, the pain of which all the opium 
that can be taken short of deathful doses will not alleviate, and yet 
water of some temperature and in some form of application will relieve 
at once. 

There are also classes of medicines called acids, alkalies, anthelmin- 
tics, liihontriplics, demulcents, etc. How, it may be asked, is water 
to substitute them? Simply by obviating the occasion for them. A 
patient has a sour stomach, and the doctor gives him soda ; another is 
afflicted with worms, and the doctor administers something to poison 
them to death; another has gravelly concretions, and the doctor ad- 
vises chemical solvents; another has acrid bile which corrodes his 
throat, and the doctor prescribes lubricating mucilages, and so on to 
the end of life. But who cannot perceive that all this practice, as a 
part of the healing art, is absurd and ridiculous ? Who so stupidly 
blind as not to see that it is a mere patch-work, tinkering at effects 
without removing causes ? The water-treatment corrects the condition 
upon which the existence of these abnormal symptoms depend, when 
of necessity they all disappear. 

In the works of the popular system we read much about " acceler- 
ating the change of matter." in order to renovate the tissues and rein- 
vigorate the functions. To do this it is recommended to bleed, purge, 
and mercurialize the patient down, and then, presto! wine, tonics, and 
" generous diet," to stimulate him up again as fast as possible, thus 
doing and undoing interchangeably. Bathing, with appropriate air and 
exercise, and plain simple food, will effect a change of matter incom- 
parably more rapid, and without the destnntion of healthful materials, 



12 THEORY AND PRACTICE. 

or the injurious "dynamic force" of alcoholic poison. If there is sur- 
plus matter about or within the body, water will wash it away, and if 
there is a deficiency of organic material, pure food and good digestion 
are the natural means to supply it. 

Again, the water-treatment, by regarding the skin as the leading 
depurating function of the body, follows out the indications of nature 
herself, which expels the greatest amount of morbific agents, whether 
miasms, effete organic matters, or drugs and medicines, from the body, 
through the cutaneous channels. Instead of wearing out the alimen- 
tary canal, where but a small quantity, comparatively, of waste or 
offensive matter is ever found, with horridly poisonous emetics and 
bowel-scraping cathartics, the principal detergent process is directed 
to the skin, where naturally five or six times the amount of excremen- 
titious matters are got rid of, that is, thrown off by the bowels. 

There is a principle recognized in the allopathic school, called 
counter-irritation or antagonism. Indeed, some late authors have 
gone so far as to consider it the fundamental principle of the whole 
drug and depleting system. It is based on the supposed law of the 
animal economy, that nature, or the vital powers, cannot maintain 
two different kinds of morbid action in different parts of the body at the 
same time. Thus, if a man has an inflammation of the stomach and 
bowels, and you produce a severer inflammation of the mouth and sali- 
vary glands with calomel, t!<e stronger mercurial excitement will 
absorb, as it were, the lesser inflammatory action ; the latter will then 
get well, after which the doctor may cure the drug-disease he has 
produced — the salivation — if he can. Such practice has no claim to the 
title of healing art ; it is doing an irreparable injury, with the ulterior 
possibility of a greater good. Blisters, issues, escharotics, and the end- 
less compounds in the shape of irritating ointments and stimulating 
Animents are predicated on no better philosophy than that of removing 
one evil by producing another. 

But admitting the fact that one disease does antagonize, or neutralize, 
or supercede another, the usual explanation is, I think, unsound. 
This vaguely-conceived "law of the animal economy" is really no law 
at all. It is the resistance that the vital powers make to morbific agents, 
which pathologists have misnamed a law of the animal economy. Two 
diseased actions, or diseases in two different parts of the body, or ob- 
structing or offending materials in two or more parts or organs, will 
manifest different phenomena from what are observed when one pari 
or organ only is affected, because vital resistance is then distributed to 
several points instead of being concentrated at one. 

If a person is laboring under a fever, that cor. motion of the organ- 



PHILOSOPHY OP WATER-CURE. 18 

ism which we denominate the febrile paroxysm is the manifestation of 
the vital struggle to defend the organic domain against some morbific 
cause, or to expel some injurious matter. If the vital powers are 
making the principal effort to the surface, the introduction of a cathar- 
tic dose of epsom salts would divert some part of this vital effort to the 
bowels to meet, defend against, and expel the new enemy which is 
committing its ravages there, and thus purgation would result, while 
the depurating or remedial effect to the skin would be materially 
diminished. The seat of war would be changed, or the battle-field 
divided, but so far from being "a friend in need," the saline purgation, 
by drawing off and wasting a portion of vital power, would only prove 
a " foe indeed." 

The water-treatment does not operate on the principle of antago- 
nism or counter-irritation, according to the popular theory, for it does 
not produce a train of morbid actions constituting a new specific disease ; 
nor does it put foreign, acrid, irritating, and deleterious ingredients into 
the blood, to produce some powerful impression at a dash, and then 
leave the vital powers to war against and waste themselves in counter- 
acting or removing them for months aud years afterward. It has been 
objected, that a cold bath was a morbid impression, as much as a hot 
blister, because it is an artificial instead of a natural method of apply- 
ing water. But this argument is short-sighted. A cold hip-bath, for 
example, produces exactly the same vital phenomena, action and re- 
action, that our bodies are subjected to every day, and hour, and mo- 
ment of our lives, differing only in degree. The first impression of 
the cold water causes the blood to recede from the canillaries ; but the 
vital powers soon meet the impression by an increased determination 
of blood to the part, to balance the temperature of the body, and soon 
the capillaries become distended with blood, the part red, turgid, and 
in a warm glow. If this process is frequently repeated, the general 
result is to develop the superficial or capillary circulation of the part, 
and to that extent unload the vessels elsewhere, remove internal con- 
gestion, etc. If the impression is too strong for successful vital resist- 
ance, if the water is too cold for the ability of the patient to react, of 
course the opposite effect results; internal congestion is increased, and 
we have die abuse of the hygienic or remedial agent. 

This determination to the surface in consequence of the impression 
of cold water, cannot be called a morbid action in any sense. If we 
go out of a comfortably warm room into a very cold atmosphere, our 
hands and face may at first become pale, cold, the vessels contracted 
and bloodless ; but on returning to the room, and often under the con- 
tinued application of the cold, reaction takes place, aud they soon 



14 THEO.ti" AND PRACTICE. 



appear more red and turgid, and feel warmer than before their expo- 
sure, for a few minutes, and then return to their usual appearance and 
feeling. So the slight disturbances of the circulation produced by ordi- 
Eary bathing is merely an intensified contraction and relaxation, amount- 
ing to temporarily increased action, and followed by the same harmony 
of circulation as existed before. Atmospheric influences, vicissitudes 
of temperature, variations of .exercise, etc., when not extreme or vio- 
lent, produce temporary disturbances of the circulation, which, so far 
from being morbid, are really sanatory, nay, indispensable to full health 
and vigor. Nature allows us a liberal range of immunity in the 
employment and enjoyment of agencies naturally harmonious with our 
structures and functions. 

But how different is the case if we take into the domain of life a 
substance chemically incompatible with its structures, or an agent phys- 
iologically incompatible with its functions. Although they are met 
with the same vital resistance as a cold bath, or a hot bath, their 
temporary impression is never succeeded by absolute equilibrium 
and quietude. They leave either a mark or a void in their track. 
When chemically incompatible, as are all the metallic and mineral 
preparations, they act upon, corrode, decompose, and destroy some 
part or portion of some constituent of some solid or fluid, of some 
organ or structvve. Familiar and melancholy examples of chemical 
incompatibility ai;i found in the ulcerations of the mucous membrane 
of the mouth, throat, stomach, and bowels, produced by the ordinary 
employment of saleratus in cooking, and the rotting of the teeth and 
bones in consequence of a mercurial course. When they are physio- 
logically incompatible, like alcohol, tobacco, opium, etc., they exhaust, 
irrecoverably, some portion of the vitality itself. The impressions of 
drug-agents of all kinds are constantly destructive or exhausting so long 
as they are kept up ; but the impressions from cold bathing may be 
continued during a whole lifetime without injury. 

It is true that, in water-treatment, we apply cold water to the body 
when hot, hot water when cold, etc., not to antagonize action, but to 
balance action; the grand general indication in treating all diseases hy- 
dropathically being to equalize the temperature, circulation, and action. 
The principle of antagonism, as practiced allopathically, tends to silence 
the efforts of nature, to counteract the vital powers, to suppress the 
organic instincts, to obstruct the vis medicalrix natures, to embarrass 
the cure, and, in the majority of cases, to place the life ofHhe 
patient in greater jeopardy than it would bo with no medication 
whatever. 

The true philosophy of water-cure, in almost every essentia point 



PHILOSOPHY OF WATER-CURE. 15 

of doctrine, is diametrically antagonistical to the prevailing theories of 
the allopathic schools. 

Some of the homeopathists have lately discovered that water acts 
on their favorite principle — similia similibus curartur. It is to my 
mind inconceivable howwater can produce, in infinitesimal or any other 
quantities, any other dynamic effects than such as are referrible to tem- 
perature, bulk, or solvency. Water is the agent which homeopathy 
employs to dilute, and thus " enlarge the surface" and develop the 
pathogenetic property of its remedies; but how it is to be reduced to 
its third or thirtieth potency by dilution, is a problem which may be 
safely laid away among the unaccountables. 

The eclectics, who" select the good and reject the bad" of all sys- 
tems, claim that water acts like a hundred other drugs which are in 
" harmony with the constitution." They pretend to eschew all poi- 
sons, and use nothing but the " innocent remedies," which are best 
adapted to *'aid and assist nature;" but, unfortunately for their fair 
pretension, we find a variety of vegetable and even mineral poisons 
among the everyday prescriptions of their writers and practitioners, 
as preparations of opium, and preparations of iron. 

Rationale of Drug-Medication. — All the standard works on 
physiology and therapeutics of the drug schools throw not a solitary 
ray of light on the modus operandi of drug-medicines. The effects 
which a thousand different drugs produce upon the various functions 
of the human body, under almost all conceivable variations of conditions 
and circumstances, have been investigated with praiseworthy industry, 
and recorded with tedious minuteness and extraordinary precision. 
But why, how, and wherefore these effects are thus and so, we are as 
ignorant, as far as their labors are concerned, as are the inhabitants of 
the moon, who, it is presumable, do not have access to their books. 
Why tartar emetic or ipecac produces vomiting, why jalap or senna 
purges, why mercury or tobacco salivates, why opium or catnip produ- 
ces perspiration, why nitre or green tea produces diuresis, why Spanish 
flies or boiling water raises a blister on the skin, why calomel or pink 
operates as a vermifuge, why aloes or iron operates as an emmena- 
eogue, etc., etc., are problems as deeply in the dark now as they were 
before the light of medical science dawned upon the world, for all that 
appears in the writings of the standard authors, or the teachings of 
living professors. 

But, fortunately for humanity, the principles upon which this ex- 
planation is founded are abroad in the world. Surely and steadily they 
are working their way into the understandings of reading and thinking 



16 THEORY AND PRACTICE. 

ceople, and just so soon ns they nre generalry appreciated will the drug 
system of treating diseases be among the things that were. These 
principles are more fully developed in the writings of Sylvester Gra- 
ham than in those of any other author. The works of George Combe 
contain some illustrations of them. The writings of Dr. Lambe, Dr. 
Alcott, Dr. Jennings, and Rausse, abound in teachings predicated on 
their recognition, while the practice of Priessnitz and his followers is 
constantly demonstrating the correctness of the explanation which 
they afford. I will try to present this matter clearly, for I am most 
undoubtingly convinced that the individual who fully understands it 
will be exceedingly loth to swallow any apothecary drug, whether it 
go by the name of drug-poison or drug-medicine ; and he who has 
both philanthropy and intelligence will be as unwilling to administer 
those foreign agents to other stomachs, as to take them into his own. 

There is a class of medicines known as tonics, or strengthening 
medicines. Books on materia medica define .them, to be such articles 
as give tone, or tonic contractility to the moving fibres, and at the same 
time augment the activity of the digestive function. Now among the 
tonics we find a most incongruous set of materials, as quinine, arsenic, 
boneset, iron, wormwood, oak bark, quassia, aloes, rhubarb, copper, 
zinc, etc. All authors agree that if the use of a tonic is long continued, 
the effect is debility. Here is a paradox. A tonic medicine first 
strengthens, and then debilitates. How are these results to be ac- 
counted for ? 

When a drug-medicine of any kind, or a poison of any kind, is taken 
into the stomach, the organic instincts recognize the presence of a 
something which is neither food t nor drink; something unnatural; 
something which has no constitutional relation to any want or duty of 
any part or organ, hence an intruder, an enemy. The vital powers 
feel an attack upon the citadel of life, and prepare to act defensively. 
The lining membrane of the stomach is aroused to increased action ; 
an unusual quantity of mucus and serum is secreted to protect the 
coats of the stomach from the poisonous or medicinal agent; but I he 
stomach does not suffer alone ; the alarm is communicated to other 
organs, to all parts of the system ; and this manifestation of increased 
vital action, this disturbance of the organism, this commotion of the 
body, is regarded by the doctors as a tonic effect ! How words 
deceive ! 

If but a few of these "tonic" impressions are r.ade on the stomach, 
if only a few doses are taken, the vital powers, after enduring tho 
siege, and defending themselves as well as may be, subside into their 
accustomed quiet, and the exhaustion, being n:t very great, is n 



PHILOSOP.tr OF WATER-CURE. 17 



specially noticed. But if these tonic impressions are kept up a long 
time, if the medicines be long continued, the vital expenditure is so 
great that the doctors onll the evidence of its loss debility ; and well 
they may. The organic instincts are finally wearied out, they become 
torpid, and refuse longer to respond to the impression ; the lash ceases 
to be troublesome. Now it is that the doctor, who wishes to still keep 
up a tonic impression, who desires to strengthen the system yet a little 
more, brings a new recruit into the field. He administers another 
tonic ; no matter what, if it be a different one. It works like a charm ! 
The vital powers, though jaded and half palsied, are not yet dead. A 
new enen>y will startle them again; an unaccustomed impression will 
again arouse them to resistance. If the first tonic was wormwood, 
the second may be arsenic, or vice versa. After the second tonic has 
spent its force, or, rather, after the vital powers cease to resist, a third 
one may be brought to bear; and so on, as long as the patience of the 
patient or perseverance of the practitioner can endure. Thus do tonics 
continually strengthen the patient, and leave him weaker in the end. 

A decisive evidence of the correctness of this explanation is found in 
the fact, that every drug under heaven can be made to operate as a 
tonic. Mercury, lead, antimony, cod-liver oil, ipecac, gamboge, aqua 
fortis, or powdered glass — as incongruous a medley as can be conceived 
— will produce tonic effects, provided the dose is such as not to occasion 
any decisive evacuant or corfesive operation, by which the article is 
suddenly evacuated, or the structure altered. Cod-liver oil and ipecac 
have both had their day of reputation for improving digestion, or fat- 
tening the body. Why? Because when taken into the stomach, that 
organ being the point of attack, the vital powers are disproportionately 
directed to that organ in defense ; and if the doses are frequently 
repeated, a determination of nervous or vital energy is established to- 
ward the digestive function. The digestive organs may thus be tem- 
porarily invigorated at the expense of all the rest of the body — a dear- 
bought method of promoting digestion and fattening the body, in the end. 

But why do some poisons or medicines produce vomiting, others 
sweating, others purging, etc. Simply because they are, by means 
of those violent or increased efforts of the excernent functions, got rid 
of. It is a law of the animal economy, that all injurious agents which 
gain admission, no matter how, within the domain of vitality, are coun- 
teracted, neutralized, or expelled in such manner as will produce the 
least injury or disturbance to the organism. If a very large dose of 
ipecac, for example, is swallowed, so large as to prove immediately 
dangerous to life, or seriously destructive to the structural or functional 
integrity of the stoinach, its action is met with such violence of resist- 



IS THEORY AND PRACTICE. 

iince as to produce severe spasmodic contractions of the muscular fibres 
of the stomach and the abdominal muscles, by which the ordinary per- 
istaltic motion of the alimentary canal is reversed, and vomiting results. 
If the dose be smaller, a piv fuse watery secretion is poured out upon 
it from the mucous and lining membrane of the stomach and bowels, 
to dilute it, and render its presence less harmful, while it is conducted 
along the alimentary canal by the ordinary peristaltic motion, and ex- 
pelled from the bowels, and thus we have a cathartic effect. If the 
dose be still smaller, it is laigely diluted with serum, taken up by the 
absorbents, carried into the mass of blood, and finally thrown off by tho 
skin, this being the manner in which a small quantity can be most 
easily got rid of, and thus we have a diaphoretic operation. If the 
dose be even yet smaller, so that no special effort of the organism is 
made to throw it off at either emunctory, the vital powers meet, de- 
compose, and destroy it in the stomach, for which purpose there is an 
increased determination of blood and of n?rvous« influence directed to 
the part, and hence we have its tonic effect. Thus may a single article 
of the materia medica produce, according to the quantity administered, 
the various and seemingly opposite operative effects of vomiting, -purg- 
ing, siveating, and strengthening ; while each effect is attended with 
an absolute waste of vital power. 

It is well known, too, that all drugs lose a degree of their potency 
by repetition ; in other words, the vital resistance is gradually overcome 
or worn out, so that, to produce the same operative effect, the dose 
must be constantly augmented. Those who find a sufficient stimulus 
in one glass of brandy per day, frequently find ten required in a few 
years to produce an equal excitement ; those who commence on one 
cigar daily, generally end with several; and those who find at first one 
patent pill sufficient to move the bowels, not unfrequently find twenty 
or thirty an inefficient dose after the vital resistance has been pretty 
thoroughly subdued. 

When medical books, therefore, tell us that drugs lose their reme- 
dial effects by long continuance, we are to understand that vital resist- 
ance is subdued ; for so long as the organic instincts act against the 
remedy, so long will the phenomena of resistance occur, which med- 
ical reasoners, starting from mistaken premises, call medicinal. It mr,y 
be remedial, and is, in a certain sense — rendering evil for evil. 

If a blistering compound, which acts chemically or corrosively upon 
the structures, is placed upon the skin, serum is poured out, the cuticle 
is raised, a collection of water is formed as a barrier to the farther 
approach of the adversary, the scarf-skin is sacrificed to save the true 
skin, and the red, turgid, inflamed blood-vessels shg>v the violence of 



PHILOSOPHY OF WATER-CURE. 



this defensive struggle. It may be that the vital energies which were 
struggling against the cause of a deeper-seated pain are so diverted to 
the new point of attack — the blistered surface — that the prior pain is 
no longer felt. The doctor calls it cured ; it may be cured, and yet 
its cause be aggravated, and the patient only the worse for the cure. 

The grand distinctive effects of homeopathic and allopathic practice 
are not to be explained on the principle of "similia similibus eurtmlwf 
nor upon the principle of "contraria contrarius curantur," nor upon 
both principles together, but upon this principle of vital resistance we 
are considering. Let me illustrate this point. 

Tea, coffee, catnip, thoroughwort, uva ursi, milkweed, etc., are 
medicinally diaphoretic and diuretic ; in other words, the vital powers 
expel them through the skin and kidneys, the expulsive effort being 
denoted by diaphoresis and diuresis. From improper food, vitiated 
air, impure water, or suppressed perspiration, the blood may be loaded 
with morbific matters, which the vital powers are naturally disposed to 
expel through these depurating organs — the skin and kidneys. Now 
while the vital powers are making a special effort to get rid of the 
special cause of disease — morbid matter — let us see what happens by 
the special introduction of a medicinal drug. Precisely this. If the 
drug be so small in dose as not to disturb seriously the first passages, 
and provoke vital resistance there — that is, if it be homeopathic — it 
passes on into the circulation, to be expelled through the skin and kid- 
neys ; thus, by adding another morbid cause to the existing one, both 
of which incite the vital powers to expulsive efforts through the same 
channels, the determination to the skin and kidneys is increased ; the 
remedy does actually increase the remedial efforts of nature, for the 
simple reason that it provides a greater duty for nature to perform. 
When the morbid matter of the disease and the morbid matter of the 
drug are got rid of, we have a cure on the homeopathic principle. 

But suppose the dose to be allopathic, that is, large enough to pro- 
duce a strong impression on the stomach and bowels, and excite active 
resistance in the first passages. Here are then two sets of vital efforts 
at work in different directions, at variance with and counteracting each 
other ; one to the skin, to expel the morbific causes of the disease, and 
the other to the primary nutritive functions, to resist the morbid matter 
of the medicine. The efforts of nature being thus divided and dis- 
tracted, are rendered inefficient for either duty; but if the impression 
of the drug be very powerful, it may produce a now disease, and draw 
off all the remedial efforts from the skin and kidneys to resist its action, 
and then we have a cure on the allopathic principle. The disturb- 
ance of the skin and kidneys is silenced, and all that is required is 



20 THEORY AND PRACTICE. 



to recover, if possible, from the factitious malady — the effect of the 
drug. 

We can more readily understand how vastly superior the homeo- 
pathic praet.iee is, in all those cases of disease, as the simple fevers and 
exanthems, wherein the efforts of nature are directed especially to the 
skin, and wherein they are, in almost all cases, when left to themselves, 
equal to the task of overcoming the difficulty. The infinitesimal dose 
does not. to any appreciable extent, hinder the success of those remedial 
powers inherent in the living organism. We can account for another 
problem, too : the superiority of the allopathic practice in a different 
class of diseases, in obstructions of and morbid accumulations in the 
alimentary canal, where the strongest impression of the allopathic dose 
can be made in the line of direction of the remedial efforts of nature. 
In the case of u simple fever the allopathic dose would interrupt the 
natural course of these remedial efforts ; but in a case of constipation 
from retained excrementitious matters, the homeopathic dose would 
work adversely. 

I am far from denying that, under certain circumstances, drug- 
medication, either homeopathically or allopathical'.y, may do much 
more good than evil, though I contend that such is not the general rule ; 
but I insist that the true healing art contemplates a method of medi 
eating diseases on an entirely different basis ; and a true basis, I claim 
is furnished by the philosophy of the Water-Cure system, which al. 
jures drugs, and depends wholly on hygienic influences. 

There is nothing in medical experience more speciously delusiv 
than the stimulating practice in cases of extreme prostration aiu 
debility. When a fever, for example, "turns," or completely subsides, 
the patient is weak and relaxed ; and if he has been severely drugged, 
he will be very weak. The doctors of all schools, except the" hydro- 
pathic, are always afraid the patient will "sink," or "run down," unless 
kept up with brandy, wine, quinine, or some other diffusible stimulant 
or tonic. Hence, no sooner is a fever subdued by reducing agents, 
than it is produced again by exciting agents, on the absurd theory of 
sustaining the uody on mere stimulation until it can recover its balance, 
or in some mysterious way acquire a faculty of existing without it. 
This "fallacy of the faculty" has been the death of no small number 
of the earth's inhabitants. 

It is no uncommon circumstance for a patient to be dosed with a 
quart of brandy, or a gallon of wine, in twenty-four hours, every 
swallow occasioning a new organic resistance, and a further waste of 
vital power, ar.d imperiling the patient's life, while the doctor is firmly 
impressed with the belief that the patient's breath remains in his body 



PHILOSOPHY OF WATER-oTJRE. 21 

only by virtue of the alcoholic stimulant. It is easy to account for this 
delusion. When the fever is up, the physician is afraid of death from 
its violence ; but he knows the patient will not die, in ordinary cases, 
until the cold stage of the paroxysm becomes permanent. When the 
fever is down — that is, in the cold stage — the patient is pale, cool or 
cold, the features sunken, and the pulse low, natural consequences of 
the previous febrile excitement. The organism now requires rest, 
quiet, perhaps nourishment. But the doctor, fearing this depression 
will end in death, kindles up the fever again. So long as the system 
will respond to stimuli, so long as the vital powers will manifestly resist 
the morbid impression of the stimulant, the body is not absolutely 
death-struck, and the doctor has the satisfaction of knowing that the 
patient is not now dying. But this evidence of his existing vitality is 
the expenditure of a part of that vitality, hence, although the stimulant 
causes him to manifest more signs of life, it also hastens or endangers 
his death, for the simple reason that it causes a further waste of 
vitality. 

But it may be objected that our theory of vital resistance, though 
applicable to those agents which produce evacuation, or increased action 
of the circulating system, will not explain the phenomena produced by 
the "narcotics, which operate in a very different mannei. Let us see. 
Medical books tell us that opium in small doses suppresses all secretions 
except the cutaneous, which it promotes. What is this but the effort 
of the vital powers, all concentrated, as it were, to expel it through 
the skin ? In large doses opium always creates nausea, and usually 
vomiting, evincive of the effort of the vital powers to expel it at once 
from the stomach. The pure narcotics, as henbane, belladonna, stra- 
monium, cicuta, prussic acid, etc., are really evacuants in relation to 
*he nervous power. Being so deadly in their influence, they are met 
with an energy proportioned to their potency of dose, and the shock, 
as it were, is often sufficient to destroy the organism ic a moment, like 
that from a Leyden jar, or a surcharged electric cloud. In very small 
doses the pure narcotics are thrown off more or less by all the excre- 
tory organs, but more especially the skin. 

In conclusion, we may find a convincing illustration in the effects of 
tlie very Sampson of the allopathic materia medica — mercury. No 
medical books pretend to explain the modus operandi cf this drug, but 
all agree that it promotes all the secretions of the body. It is this gen- 
end effect upon all the secretions which causes mercuiy to be regarded 
as a universal alterative, and administered, too, so freely and so fatally 
in almost all the diseases incident to humanity. But hoiv and why does 
mercury promote the activity of jj! the secreting organs ? Because 



22 



THEORY AND PRACTICE. 



its operation is, although very slow and gradual, is chemically destructive 
to some of the constituents of all the fluids and solids of the body; 
hence it is every where met with active vital resistance, either to expel 
it al (he natural outlets, or involve it in mucous, so as to neutralize or 
lessen its ruinous consequences while it remains in the system. lis 
universally remedial operation is only the evidence of universal war in 
the organism, the final result of which must inevitably be universal 
ruin, to a greater or less extent, of the vital powers. 



CHAPTER II. 



WATER-CUKE PROCESSES. 

The hydropathic appliances embrace all the usual methods of vapor, 
warm, tepid, cool, and cold bathing, besides a variety' of processes 
which have had their origin in the development of Water-Cure as a 
By stem. 

„. .„. The Wet-Sheet Packing. 

Fig. 164. 

— This process, the lien tuck of 
the Germans (fig. 164), is admi- 
rably calculated to answer two 
general indications, which are 
manifestly leading ones in a long 
catalogue of maladies, both acute 
and chronic, viz., to reduce the 
heat of tVie body and the force 
of the circulation, and, as an al- 
terative, to correct morbid and 
restore healthy secretions. It 
produces also, incidentally, a 
powerfully detergent or cleans- 
ing effect, and generally exerts 
a wonderfully sedative or sooth- 
ing influence on the whole nervous system. The first disagreeable 
sensation of cold is usually soon followed by a pleasurable warmth over 
the whole surface. It is capable of superseding, to advantage, bleeding, 
antimony, salts, hydriodate of potassa (iodide of potassium), calomel, 
and opium, and n hundred oilier more or les° injurious agents. 




THE WET-SHEET PACKING. 



WATER-CURE PROCESSES. 23 

In fevers, and in all acute inflammatory disorders, it mny be employed 
with a freedom exactly proportioned to the degree of morbid heat and 
force of the pulse ; that is, continued, with frequen'" changes, until the 
temperature and circulation are reduced to the natural standard, and 
the skin becomes soft and perspirable. Much sweating is not usually 
to be desired. 

• In nearly the whole range of chronic complaints, there is one prev- 
alent morbid condition, ever varying in intensity, yet consisting essen- 
tially in a deficiency of blood in the superficial and capillary vessels, 
and an accumulation or engorgement in the large internal vessels, with 
consequent congestion in some one or more of the viscera. To reverse 
this condition, relieve the overburdened internal organs, and supply the 
deficient external circulation, the wet-sheet process, aided by the proper 
auxiliaries, is the best known remedial agent. 

Dr. Gully we!! remarks : "This process repeated day after day, and 
sometimes twice daily, at length fixes a quantity of blood in the blood- 
vessels of the entire skin, and thereby reduces the disproportionate 
quantity which was congested in the inner skin, or mucous mem- 
branes." 

If any one doubts the purifying efficacy of this process, he can have 
a "demonstration strong" by the following experiment: Take any man 
in apparently fair health, who is not accustomed to daily bathing, who 
lives at a "first-class hotel," where they fatten their own chickens and 
pigs on the refuse matter of the kitchen, takes a bottle of wine at 
dinner, a glass of brandy and water occasionally, and smokes from 
three to six cigars per day. Put him in the "pack" and let him 
" soak" one hour or two ; on taking him out, the intolerable stench will 
convince all persons who may be present that his blood and secretions 
were exceedingly befouled, and that a process of depuration is going 
on rapidly. 

The time for remaining "packed" varies greatly in different cases. 
The average time is from thirty to sixty minutes, though in some few 
cases fifteen minutes is long enough, while others may remain envel- 
oped two hours to advantage. Persons of highly nervous tempera- 
ment, and rapid though feeble pulse, and those laboring under great 
debility with considerable irritability, should remain in the wet sheet 
only until the body becomes comfortably warm. Those having a more 
torpid circulation and phlegmatic temperament, unattended with much 
debility, may remain a much longer time. 

Much of the comfort or disagreableness of the process depends on 
the skill and dexterity of the attendant. There is at least as much 
science in applying wet cloths to the naked body as in rubbing in an 



24 THEORY AND PRACTICE. 

ointment or putting on a blister. A person may be wrapped up so 
slowly, loosely, and unevenly by an awkward hand, as to find the whole 
affair from beginning to end exceedingly uncomfortable ; or the cloth- 
ing may be so rapidly and nicely adjusted, as to give the patient an 
hour or so of actual enjoyment. 

Light cotton, hair, or sea-grass mattresses, or even straw, for those 
accustomed to very hard beds, may be used for " packing." On one 
of these spread from three to five large thick comfortables, then a 
pair of soft flannel blankets, and, lastly, the wet sheet lightly wrung 
out, so as not to drip. Two pillows placed on the mattress are neces- 
sary for the head. The patient, lying down flat on the back, is quickly 
enveloped in the sheet, followed by the blankets and comfortables. A 
light feather bed may be thrown over the top, in which case two com- 
fortables less will be required. If the feet remain cold, bottles of hot 
water should be placed to them. Headache is prevented or removed 
by the application of cold wet cloths. In wrapping up the patient, 
great care should be taken to turn the clothing snugly and smoothly 
around the feet and neck. For very delicate persons, the sheet should 
at first be wrung out of tepid, or even warm water. On coming out 
of the " pack," the plunge, douche, rubbing wet-sheet, or towel 
washing may be employed, as either is speedily indicated. 

Some hydropathists recommend the sheet to be wrung as dry as 
possible, and others advise it te be used quite wet. I prefer a very 
wet sheet in all cases wherein the patient is not deficient in external 
heat. When the skin is very cold and torpid I would advise it to be 
as dry as the attendant can conveniently wring it. 

Some persons, whose pores are pretty effectually closed up with 
bilious .accumulations, find it rather difficult to get entirely warm at 
first. In a few days, however, the glow comes up readily, and it 
-ceases to be dreaded. Such cases are benefited by a good deal of 
friction to the skin over the wet, and then the dry sheet. 

There are some few patients, of weak vital energies and extreme 
susceptibility, who very soon get warm in the wet sheet, and imme- 
a.ately after grow chilly again ; and in some cases, if they remain yet 
half an hour longer, a comfortable reaction will come on again. Such 
persons should be taken out, if possible, during the glow upon the sur- 
face. If it so happens that they get an unpleasant chill after comina 
out, a thorough rubbing, followed by fifteen or twenty minutes dry 
packing, will usually obviate all injurious consequences. 

Headache, languor, muscular debility, and giddiness, if serious and 
long continued, generally indicate that the envelop has been continued too 
long. When they occur repeatedly the time should be shortened. 



WATER-CURE PROCESSES. 



25 



A linen is always to be preferred for " packing," more especially in 
■Warm weather. 

The wet sheet is not a sweating process, as generally supposed, 
although frequently a moderate, and occasionally a copious perspiration 
takes place. It is permanently either a cooling or a heating process, 
according to the degree of envelopment. When the object is to reduce 
fever or inflammation, the patient should be lightly covered, and the 
wet sheet frequently renewed. In chronic diseases, when the inten- 
tion is to produce reaction and develop the external circulation, an 
additional quantity of bedding secures this object. As a cooling pro- 
cess, it may always with safety be frequently repeated, until the force 
of the pulse and the preternatural heat are reduced to the normal 
standard. Under its judicious employment in chronic diseases, the 
skin gradually becomes softer, velvety, and more porous and delicate ; 
its structure more firm, and its functions more vigorous. 

The Half-Pack Sheet. — This is the application of tike wet sheet 
as above to the trunk of the body only. It is milder, yet less effica- 
cious, than the full pack. It is only employed on feeble persons, who 
have not sufficient vitality for the whole sheet, or as a preparatory 
measure for the entire envelopment. 



The Douche. — The primary 
object of the douche (r/oosh) bath, 
fig. 165, is to arouse the activity 
of the absorbent system, and this 
it certainly accomplishes in a most 
powerful and effectual manner. 
It is well adapted to chronic en- 
largements of the viscera, tumors, 
swellings and stiffness of the joinls, 
local attacks of gout and rheuma- 
tism, obstinate constipation, the in- 
cipient stage of tubercular con- 
sumption, and many other disor- 
ders. The force of the stream 
and time of application should be 
carefully adapted to the strength of the patient. Very nervous per- 
sons, and those subject to a determination to the brain, must resort to 
it with extreme caution. Generally the stream should be directed to 
the back of the neck, along the spine, hips, and shoulders ; in chronic 
swellings of the joints the stream may be directed to the affected 
II — 




THE DOUCHE 



26 THEOltY AND PRACTICE. 



parts ; in cases of torpid bowels a moderate stream may be applied to 
the external abdominal muscles. No strong douche should ever bo 
taken on the head, nor should it be long continued on any one spot 
about the spine or back bone. 

Douches may bo so constructed as to produce any degree of impres- 
sion, from that which is scarcely appreciable, to one as powerful as the 
muscular system can endure, according to the size of the stream, its 
fall, pressure, etc. They may be vertical, oblique, horizontal, or as- 
cending. Those most generally in uso are perpendicular streams from 
one to two inches in diameter. Smaller streams, as inch and half 
inch are better in some cases. The oblique and horizontal streams 
can be more conveniently applied locally when indicated, and in many 
cases, as in difficult respiration, it is advantageous to have the bodily 
position erect during its application. The ascending douche is particu- 
larly valuable in piles, prolapsus of the uterus or bowels, constipation 
from debility, etc. The stream should not be forcible enough to cause 
absolute pain nor serious inconvenience; the stream may be half an 
inch to an inch. 

Warm water douches have been employed but little comparatively, 
but I think they are destined to grow in favor. In many cases of 
rigidity of the muscles, painful swellings, chronic inflammations of the 
joints, in neuralgic affections attended with extreme nervous irritabil- 
ity, and in spasmodic and bilious colic I have known excellent effects 
from streams of warm water applied to the parts affected. They are 
also useful in obstinate constipation, retention of urine, amenorrhea, 
etc. As the object of a warm douche is to relax instead of contract- 
ing the muscles of the affected part, a small stream long continued is 
the best ; it should be followed by the cold dash for a moment. 

The hose-bath is a modification of the douche ; it may be employed 
horizontally or obliquely to any part of the body, the force being 
regulated by a stop-cock. " 

The Rubbing Wkt-Sheet.— This bath produces a strong and 
general determination to the whole surface. The shock is generally 
rapidly succeeded by vigorous reaction, which is further promoted and 
maintained by active friction. It is applicable in all cases wherein a 
■strong diversion from the internal viscera, or the mucous membrane 
of the alimentary canal, to the skin, is required. " It is more or less 
serviceable in nearly every condition of disease wherein the patient 
has sufficient reactive energy to prevent a permanent chill. In the 
primary stage of fevers, in the early stages of bowel complaints, colic, 
diarrhea, dysentery, cholera, etc., it. is particularly valuable. In these 



W A T E it - C U It E PROCESSES. 



27 



cases it should bo applied frequently for a few minutes, and the skin 
rubbed energetically and perseveringly. In the great majority of skin 
diseases it is among the best resources of hydrotherapia. It is one of 
the best kind of " wash-downs" to follow the pack. 

The rubbing wet-sheet is an admirable bath for the sedentary and 
studious; for exhaustion consequent on severe mental exertion; for 
mental disorders, and many states of insanity ; for nearly all spasmodic 
and epileptic conditions ; foi delirium tremens ; for night sweats, 
watchfulness, nightmare, etc. 

When employed drippingly wet (the uHpping sheet), a large tub or 
dripping pan is necessary for the patient to stand in. When wrung 
so as not to drip it may be used in any room or on a carpeted floor. 
The sheet is thrown suddenly around the patient's body, which it 
closely envelops from the. neck to the feet, and the body is nibbed by 
the hands of the attendant outside the sheet; in ordinary cases five 
minutes are sufficient. Some prefer a larger sheet thrown over the 
head and reaching down to the feet, by which the patient can himself 
exercise by rubbing in front while the attendant rubs the back part of 
the body. I do not see any special advantage in this to offset its 
awkwardness. The patient can and should make active friction over 
the chest, abdomen, and lower extremities, if the sheet is thrown 
around the neck, leaving the head out. It is succeeded by the dry 
rubbing sheet, or rubbing with dry towels. 



The Hip or Sitz-Bath.— The Fig. 1C6. 

sitting-bath answers the several -a- - 

indications of tonic, derivative, and 
sedative. It is invaluable in weak- ; 
ness, irregularity, obstruction, and 
torpor of the lower organs of the 
pelvis and abdomen. Any com- 
mon wash-tub will answer for its 
administration, though it is more 
convenient to have vessels made 
for the purpose, the bottom raised 
a few inches from the floor, the 
back side raised to rest against. 
The water, as a general rule, 
should cover the hips and lower 
portion of the abdomen. It may be of any temperature, from very 
warm to extreme cold, according to the case; and the time of appli- 
cation varies from five to thirty minutes. The cool and cold sitting- 




THE SITTING-BATH. 



28 TIIEOKY AND PRACTICE. 



baths are far the most frequently indicated, and the usual time is from 
ten to fifteen minutes. 

In the cold stage of fever, the warm sitz-bath very much mitigates 
the severity of the chills, and, if followed by the cold-rubbing wet 
sheet when the hot stage of the paroxysm supervenes, will often break 
up the attack in a few hours. In acute inflammations of the liver, 
stomach, bowels, spleen, and kidneys, hip-baths should be used very fre- 
quently, conjoined with the plentiful use of tepid or cool water in 
injections. Debility of the external muscles of the abdomen, caused 
bv the excessive use of tea and coffee, or crooked positions of the 
body, evinced by short breath, weakness in the small of the back, and 
trembling of the knees, is greatly benefited by this process, used as 
cold as can well be borne. A blanket is usually thrown around the 
patient during this bath. 

The best tonic effect of hip-baths is secured by having them of short 
duration — five to fifteen minutes — and frequently repeated. 

A derivative effect is obtained by longer baths — fifteen to thirty 
minutes — and at greater intervals. It must be noticed, however, that 
the effect of any bath is determined as much by the condition of the 
patient as the length of the bath. Tonic hip-baths are more or less 
derivative ; but to get the greatest derivative effect, the bath should be 
continued as long as reaction is vigorous, but not carried to the extent 
of producing the second chill ; if so, determination may take place to 
the internal organs instead of derivation from them. Derivative hip- 
baths should not be carried to the point of producing paleness or livid- 
ness of the lips, general shivering of the whole body, nor nausea at 
the stomach, for they would thus endanger congestion of the brain or 
lungs. In treating affections of the head and chest, for which this 
bath is one of our best resources. d -reat caution should be exercised in 
managing them so as to secure a derivative without producing a re- 
vulsive effect. 

Some of the effects of sitting-baths, usually called derivative, are 
really sedative ; no matter, though, so long as they work curatively. 
In a general fever, for example, when the whole body is preter- 
naturally hot and turgid, a long-continued bath of tbis kind operates as 
a refreshing and fever-assuaging sedative. 

The temperature of the water, and its quantity, also have some 
influence in determining whether its effects shall be tonic, derivative, 
sedative, or repellant. The rule of practice, is to lessen the quantity 
of water, or raise its temperature, according to the coldness, torpor, 
and debility of the patient. 



WATER-CURE PROCESSES. 



29 




The Shallow-Bath— This. Fig. 167. 

ns usually employed, is a power- 
fully alterative, mildly derivative, 
and moderately sedative bath. It 
is sometimes used cool, seldom 
very cold, but generally tepid, 
from 65° to 75". The common 
shallow-bath tub may be used, 
but a circular or oval tub, raised 
about twelve inches from the 
floor, is more convenient for the 
attendant. In private families 
any tub large enough for the pa- 
tient to sit upright will answer. 
The water should bo from four THE shallow-bath. 

to six inches deep. During the bath the abdomen and lower part of 
the body should be well rubbed by the patient if able ; if not, by an 
attendant; while the head is sprinkled and the back and chest rubbed 
by the attendant, who sprinkles those parts, or dips his hands occasion- 
ally in water. When there is no chilliness, a pail of-cold water (Ike 
fail douche) should be poured on the chest and shoulders to complete 
the process. This bath may be employed from one to fifteen minutes 
with those who are very feeble and sensitive to cold, and from fifteen 
to thirty minutes with others. It is usually followed by the dry rub 
sheet ; sometimes also by the hand rubbing. When used for a long 
time, the water is renewed as often as it becomes quite warm. 

Many nervous and delicate invalids will find this the best bath to fol- 
low the wet-sheet pack. It is also one of the best leading baths in 
the treatment of cutaneous affections, in mineral diseases, in mercurial 
affections of the joints, in sick headache and "rush of blood to the 
head," in apoplectic, epileptic, paralytic, and hysterical affections, in 
' sun-stroke," intoxication, delirium tremens, etc. 

In some instances the half-bath has been continued for several hours 
with decided benefit. When there is ui.iform and preternatural heat 
of the surface, in any of the above-named diseases, it may be pro- 
tracted as long as those symptoms can hold out, with perfect safety ; 
but in all other cases short baths often repeated are preferable to very 
long ones; the former are never dangerous, the latter possibly may bo. 



The Half-Bath. — The half and shallow-baths are often spoken 
of as the same. Some authors make a distinction by calling the ordi- 
nary shallow-bath a hnlf-bath, when the water is about one foot in 



THEORY AND PRACTICE. 



depth, so as to cover t ,e lower part of the abdomen, as well as the 
lower extremities. This is in effect intermediate between the shallow- 
bath and full-bath, or plunge, and is employed when the reactive 
power, of the patient admits of a stronger impression than the former, 
yet is not sufficient for the shock of the latter. It is specially adapted 
to those cases for which the shallow-bath is indicated, when they are 
complicated with great weakness of the external abdominal muscles, 
deficient action of the kidneys, obstructions of the liver, leucorrhea, 
menorrhagia, etc. In relation to time and temperature, it is to be reg- 
ulated by the same rules as the shallow-bath. 

Dr. Johnson (Domestic Hydropathy) says, in allusion to this bath : 
"Place m& under the most unfavorable circumstances, viz., in the 
heart of a large town, let me have my fair average of all sorts of cases, 
new and old, acute and chronic, slight and severe, and give me the 
shallow-bath, the sitz, and the wet-sheet, and no other, bath whatever, 
and let me have an opportunity of frequently seeing my patients — I 
would undertake to cure or relieve more cases than are now cured or 
relieved by the ordinary drug-treatment in the proportion of two to 
one." I think the doctor is safe enough. It would not become me to 
speak for London practice, but as for drug practice in New York, I 
would confidently undertake the same task with either one of these three 
baths, or with a pail of pure soft water and a crash towel, without 
either of them. 




GOING FROM PACK TO PLUNGE. 



The Plunge-Bath. — Immers- 
ing the whole body up to the neck 
quickly, when the patient has 
room and opportunity to exereise 
his limbs under water, is all that 
is essential to the full benefit of 
this process. It is generally pre- 
ferred after the sweating process, 
and very frequently after the wet 
sheet, by those who are able to 
bear the exertion. The patient 
wears the wrapping-sheet and 
blanket (fig. 168) to the bath, hav- 
ing his feet sufficiently released 
to walk, and as a useful pre- 



caution, wets the head and chest, and then plunge* into the water 
either head-foremost or fcct-foremost, as he fancies. The shock pro- 
duced is much e?s than most persons vould suspect, while the reaction 



WATER-CURE PROCESSES. 31 

is generally rap : d, equal, and extremely agreeable. It may be advan- 
tageously employed more or less in the majority of all chronic diseases 
which are not attended with strong determination to the brain, great 
disturbance of the circulation, or difficulty of respiration. It is one of 
the most pleasant and refreshing morning baths taken on first rising 
from bed ; and by all, except the very feeble, it may be employed 
colder than any other bath can be, with equal comfort. 

Invalids with lungs so tuberculated as to prevent a full inflation, do 
not bear the plunge well, nor persons laboring under organic alfections 
of the heart, nor those laboring under dropsical accumulations of the 
chest or abdomen ; in these cases it disturbs the circulation and respira- 
tion too much. But with all invalids or other persons who have mod- 
erate vigor and a pretty well-balanced circulation, with no serious local 
determinations or organic lesions, there can be no more agreeable or 
exhilarating bath. 

A plunge-bath may bo easily constructed wherever there is a run- 
ning stream. A square plank box, four or five feet in depth, makes a 
good and cheap one ; its dimensions may be large enough for a swim- 
ming-bath to advantage, if there is room. 

The temperature of the plunge is usually from 55° to G5', and the 
time for remaining in the bath varies from a very few seconds to two 
or three minutes, in chronic diseases; in high fever or general inflam- 
mation of the whole system, the patient may remain ten or fifteen 
minutes — at all events, until thoroughly cooled. 

The Foot-Bath. — Most persons are aware of the intmiate con- 
nection between the whole nervous system and the feet, manifested 
by the extraordinary susceptibility of tho soles of the feet to external 
impressions; and such persons must readily appreciate the importance 
of this remedial appliance. The potency of mustard, onions, garlic, 
vinegar, ginger, pepper, and other pungents, applied to the feet, in a 
variety of aches, pains, cramps, and spasms, has long been celebrated 
among physicians and nurses. The intelligent hydropath will admit 
the importance of the principle — sympathy — upon which tho employ- 
ment of those articles has been based, while he will produce every 
desirable result of them all with simple water. As a derivative in, af- 
fections of the head and chest, it is often used in connection with the 
sitz-bath, with which it may be advantageously alternated. To prevent 
or remedy habitual cold feet, it is absolutely indispensable in a hydro- 
pathic course. Active exercise, in this case, should generally precede 
and follow the cold foot-bath. The rules given for the regulation of the 
Eitz-bath will apply to this. Any vessel large enough to admit the ftet 



THEORY AND PRACTICE. 



The time 



and water enough to cover them ankle deep, will answer, 
is usually from ten to fifteen minutes. 

Persons of very feeble circulation, and who are unable to take much 
exercise, should use shallow foot-baths for about five minutes, the 
water being not more than one or two inches deep. The feet or 
toes, or both, should be kept in motion during the bath. Walking foot- 
baths, where a stream of cool water can be found with a clean bottom, 
is a most efficient remedy for habitual .-old feet, and one of the best 
appliances for chronic headache, restlessness, sleeplessness, and also 
one of the most excellent and efficient strengthening processes for 
almost all forms of female weaknesses and obstructions. 

The warm foot-bath is often valuable to relieve sudden attacks of 
headache, and soothe the nervous system when unusually irritated. 
Many delicate invalids who are habitually liable to cold feet, will find 
the wet-sheet pack more pleasant and agreeable by putting the feet in 
warm water for three minutes before being enveloped. 



Fig. 169. 

iP 1 



The Head-Bath. — The com- 
mon method of bathing the head is 
by folds of wet cloths, or a stream 
of water poured over the head. In 
all acuto diseases about the head, 
attended with pain and increased 
temperature, those processes are suf- 
ficient, but in some chronic affec- 
tions a powerful derivative or sedative 
effect is desired. For this purpose 
the patient lies extended on a rug or 
mattrass (fig. 169), the head resting 
in a shallow basin or bowl, holding 
two or three inches of water, tho 
shoulders being supported by a pil- 
low. It may be administered from fifteen to thirty minutes. 

"When the pouring head-bath is employed the patient lies face down- 
ward ; the head is hold by the attendant and projecting over the side 
of the bed ; the bedding being protected by a sheet or blanket thrown 
around the patient's neck ; a tub is placed under the head to catch the 
water. The water is poured from a pitcher or other convenient vessel 
moderately but steadily for several minutes, or until the head is well 
cooled, the stream being applied principally *o the temples and back 
part of the head. This process is excellent <n all high fevers, and in 
the early stages of colic and cholera morbus 




THE HEAD-BATH. 



WATER- OUIIE PROCESSES. 



Fig-. 170 represents a convenient vessel for a Fig. 170. 

head-bath. Length from a to b, 11 inches; ^__ — ^ == =?== = — -^___ 

breadth from c tod, 8 inches; depth, 3^ inches; /lSl£$r ^ ^^^Ny 

height from the floor, 7 inches. The bottom is fm^.'k'- i sill 

The cold cloths, or pouring stream \ ^S^z^^t#^*« 

is beneficially employed in convulsions, ^^^tt^mmmi^^Kr^ 

delirium tremens, rheumatic affections y";) : >w 

of the head, transferred gout, epilepsy, /^^'WH^L. 

npoplexy, nose bleed, inflammation of xC^C ^yS^HJk 

In chronic diseases of the eyes and 
ears, earache, partial or complete loss VESSEL F0R THE head-bath 
of hearing from debility of the auditory nerves, dimness of vision from 
local debility, morbid depositions in the humors or structures of the 
eye, chronic catarrh, etc., the bathing vessel is advantageous. 

The Shower-Bath. — This bath is greatly misused by many per- 
sons, and is generally sadly mismanaged by allopathic physicians. 
Cases like the following are everyday affairs in New York : A patient 
has been under drug-treatment a long time without benefit; he has 
been entirely unaccustomed to regular bathing in any manner, and has 
never taken a cold bath, nor has the doctor even hinted at any sort of 
a bath during his whole course of medication. But, getting discour- 
aged, the patient begins to annoy his medical adviser with questions 
about the Water-Cure ; the latter speaks in the highest terms of the 
remedial uses of water in the hands of competent persons; thinks it is 
a very good remedy indeed in many cases, but in this particular case 
it probably would not answer ; it might produce congestion'. Still the 
patient may, if disposed, ',rj it and see — that is, on his own responsi- 
bility. He may try a shower-bath, and ascertain thereby how the 
treatment will be likely to operate. Influenced by these loose inuen- 
does, and without any precautions or regulations, the patient takes 
Lwo, three, or half a dozen shower-baths. Each one gives him a dis- 
agreeable chill, perchance a violent headache, and makes him feel 
decidedly worse in every sense. He goes back to the doctor, who 
shakes his head portentiously, looks "wondrous wise out of all his 
eyes," and exclaims, " I was afraid it wouldn't work well ; cold water 
is a veiy powerful agent; very dangerous when not properly managed." 
Now the shower-bath is excellent in its place, but in almost all cases 
it is the very worst bath to commence on an invalid with. Generally 
patients require considerable freparatory treatment before they can 



34 



THEORY AND PRACTICE. 



take it to advantage. Although it is m«ve frequently P™^ than 
any other bath by the drug doctor, the hydropath would soonex d,s 
nen^e with it entirely than with any other. 

1 The hovver-bath can be employed profitably only by those who 
have a good degree of vital heat, and a rather act.ve and pretty well 
balanced circulation. It is contra-indicated in very nervous and ex- 
tremely susceptible persons, in those liable to nervous headache, pal- 
pitation of the heart, great determination to the lungs, or severely 
constipated bowels. 

Whether it should ever be taken on the head is a controverted pro- 
position. Many persons, to my certain knowledge, have taken it freely 
on the head as well as all over the body, as a daily bath, for years, not 
only without an^ unpleasant symptom, but with uniform pleasure and 
advantage. But I have known many invalids with whom it would oc- 
casion more or less headache or giddiness, when applied to the head, 
and none whatever when only taken upon the rest of the body. The 
safest general rule is to direct patients to incline the head forward so 
as to let the shock fall upon the neck, spine, and shoulders. It may 
also be freely applied to the chest and abdomen. 

Its principal advantage is in affording a convenient morning bath; 
a good wash down after the wet sheet, when no other bath is specially 
indicated, and also after the hot and vapor baths. 

In the stupor of drunkenness a smart shower of cold water often 
restores sensibility very promptly. The cold shower has recently been 
introduced into the penal transactions of our criminal code. Refrac- 
tory culprits are often brought to prompt obedience by its terrors. The 
prisoners are said to dread it worse than the old-fashioned, barbarous 
methods of flagellation. It is certainly more humane, but is liable to 
do injury to those who are extremely susceptible, with a tendency to 
head affections. 

This bath has long enjoyed considerable repute as a popular remed/ 
for i.ckets and other cachetic affections of children. It is managed 
so injudiciously in home practice as to work more mischief than bene- 
fit, as the following anecdote will illustrate I once saw what was in- 
tended for a shower-bath, administered in this fashion ; a good mother 
became anxious about her little boy, who was about a year and a half 
old; he appeared to be "poorly," without having any particular dis- 
ease for which a name Gould be found. The doctor gave it oil, rhu- 
barb, "a touch of calomel," elixir drops, worm seed, and strengthening 
things in abundance, but it stayed " poorly." Some kind neighbor ad- 
vised showering, and the nvjther concluded to try it. The next morn- 
ing, wh'ch happened to be of a keen, blustering, November day, the 



WATER-CURE PROCESSES. 



as 



mother, at early sunrise, drew a paiiul of water from the bottom of a 
deep well, stripped the child naked, placed it out-door on the bare 
cold ground, and then threw the pail-douche over it at a single dash ! 
The result was a fever, which lasted the child a week. The child 
should have been placed in a tub in-door, and the water poured over 
it gently. 



The Cataract-Bath.— This is a Fig. m. 

pleasant yet powerfully excitant bath. a 

Dr. Johnson, from whose work I take 
the illustrative cut, thus describes it : 

In Fig. 171 a and b are two tin cylinders, con- 
taining six or eight gallons each. These are 
fixed at the top of the frame-work of an ordi- 
nary shower-bath, the common cistern and 
perforated plate being removed. By pulling a 
string, these cylinders are tilted so as to dis- 
charge their water, as is seen in the plate. Tho 
inner side of each cylinder should have a lip, to 
give a more forward direction to the cataract 
of water. 



The cataract-bath may be employed 
for the same general purposes as the the cataract-bath. 

douche. It is a good substitute for the wave-bath, and for the plunge 
in those who cannot bear the exertion required by the latter. 




The Dry Pack, or Sweating-Bath. — Wrapping in the dry 
blanket is managed precisely as the wet-sheet packing, with the omis- 
sion of the wet sheet. The flannel blanket conies in contact with the 
body, and a sufficient quantity of blankets, comfortables, or other 
bedding is thrown around to retain the animal heat. Very nervous 
and irritable persons should not be wrapped very tightly about the 
chest. A wet napkin should always be applied to the head, and the 
room should be well ventilated. The sweating process usually occu- 
pies two or three hours. Some few persons will perspire freely in 
less than an hour, and some will remain four or five hours without 
sweating much. 

"When the patio it perspires with difficulty, exercising by extending 
the limbs forcibly, accompanied with deep, full inspirations, will very 
much accelerate the process. One, two, or three tumblers of watei 
are taken at intervals during the envelopment. Dr. Johnson recom- 
mends a little allopathi • auxiliary in the shape of " a pint of hot, weak, 



THEORY AND PRACTICE. 



black tea !" I would recommend the patient to abstain, teetotally, from 
all such nonsense. 

The patient should never remain long enveloped after sweating has 
become copious ; it is much better to perspire moderately and fre- 
quently. On coming out of the sweating-blanket, some form of cool or 
cold bath should be taken, as the plunge, douche, shower, shallow- 
bath, or dripping-sheet. The sweating process is one of the severest 
of the Water-Cure appliances, and must always be managed with care 
and discrimination. If the patient becomes very restless, or if trouble- 
some headache, giddiness, or palpitation come on, he should be taken out. 
Patients will usually bear this application better after a few repetitions. 
Many people suppose, and some medical writers represent — among 
whom is Dr. John Bell, in his able work on Medical and Dietetical 
Hydrology — that the sweating process is a regular part of the hydro- 
pathic routine. This is a great mistake ; sweating is not the rule, but 
the exception in water-treatment. It is very seldom resorted to ki 
any respectable establishment, and Priessnitz recommends it now 
much less frequently than formerly. It is the nearest approach to 
allopathic treatment of any of our processes, being, when long contin- 
ued, depletive and debilitating. 

The sweating process is not applicable to any particular disease by 
name, but to a particular condition of body which is found in several 
diseases. This condition is called plethora in medical books ; it means 
over-fullness, grossness of the system. It is most frequently found ii 
gouty and rheumatic subjects. All very fat or corpulent persons pos- 
sess it, of course. It is the result of high living and indolence or of 
active alimentation combined with defective depuration. Persons 
afflicted with that unsightly disorder, obesity, can be assisted down to 
the standard of normal bulk and personal comeliness by this manner 
of sweating, providing the alimentary supplies are also healthfully cur 
tailed. J 

The dry-blanket packing is very useful for those invalids who are 
too feeble to exercise sufficiently to overcome the chill produced by 
the wet-sheet pack, or other cold applications. With such, too, wrap 
ping for half an hour to an hour is a good preparatory measure for 
other baths, and it may follow any bath when desirable to thus assist 
reaction. 

There is another class of invalids still who may find benefit from th 
dry packing ; those who suffer occasionally, and at irregular intervals 6 
severe rigors or chills, proceeding from enlarged liver or spleen' S ' 
slight ulcerations >r tuberculations of the lungs. Though it will „ot 
prevent the chills, it will materially mitigate their severity, nnd thu 



WATER-CUKE PROCESSES. S', 

indirectly assist the final removal of the cause. For this purpose the 
patient may be enveloped ai; any time when the chills trouble him, and 
remain until comfortably warm and fatigued with the position. 

The Vapor-Bath. — Somewhat akin to the sweating-blanket is the 
vapor-bath. Some hydropathic practitioners regard the vapor, and 
shower, and all other modes of water-treatment which were not pre- 
scribed by Priessnitz, as anti-hydropathic, as though nothing was ever 
to be learned save what Priessnitz personally taught, and nothing ever 
to be done save a routine repetition of his acts. Between the vapor- 
bath and sweating-blanket there is a difference in favor of the latter 
It does not disturb the circulation, quicken the pulse, or affect the 
respiration as much as does the vapor-bath, nor is it as liable to abuse 
from ignorance or carelessness. This last objection, however, applies 
rather to the usual than the necessary result of the vapor-bath ; for, 
if not made too hot, nor administered too long, the effect is scarcely 
ever disagreeable. It is better adapted to torpid, phlegmatic coiistitu- 
tions, than to the nervous or irritable, other circumstances being equal. 
It is valuable — yet not equal to the wet-sheet— in many forms of skin- 
diseases unattended with much irritation. In sudden colds, coughs 
from suppressed perspiration, in the incipient stage of most forms of 
rheumatism, in the first access of simple fevers, in influenza, and in 
mercurial diseases, it is more especially serviceable. It should never 
be continued to the point of producing dizziness, faintness, nausea, nor 
great lassitude. Some form of cold-bath should always succeed it, as 
the shower or plunge. The average time for remaining in a rapor- 
batn, when the steam is as hot as can be borne without discomfort, is 
from fifteen to twenty-five minutes. 

The "steam doctors" have brought vapor-bathing into unmerited 
disrepute by overdoing it. Many patients have been " steamed" so long 
as to produce a degree of muscular relaxation arid vital exhaustion, not 
fully recovered from in years. The process is, in their hands, usually 
accompanied with hot and stimulating drinks, "composition," "No. 6," 
etc., and frequently followed by a lobelia emetic ; all together making a 
power of medication which only very robust persons can endure with- 
out serious injury. Another error in the steam practice consists in not 
employing a sufficient amount of cold water after the hot vapor. Gen- 
erally the patient, when excessively heated, is dismissed with a mere 
sprinkling of a pint or quart of cold water, when he should have a 
dripping sheet, plunge, or half-bath. A vapor-bath can be contrived in 
many ways. The invention of Mr. Jeremiah Essex, of Bennington, 
Vt., combines as !nr»py conveniences as any plan I have seen. 



THEORY AND PRACTICE. 



Fig. ITS 



Fig. 172 is an inside elevation of 
Mr. Essex's bath, showing the ar- 
rangement by which a person can 
take a cold or warm shower, or a 
vapor-hath at pleasure. The out- 
side casing is the box ot tbe bath, 
which may have screen sides, like 
the common kind ; and the tubes 
below, as they are small, and lying 
on the floor (the one, F, may ru-n 
below the floor), can be of no in- 
convenience. C is a small circular 
vessel of water surrounding the 
tr je, E, seen in section, and com- 
municates with it by a small open- 
ing inside, near its bottom. When 
the tube, E, is nearly filled, the 
vessel or chamber, C, contains 
water to the same height. F is a 
conducting pipe extending up into 
the tube, E ; and A is the handle of 
a piston, which extends down intd 
E, having its lower end made to 
force the water up through tbe 
pipe, F, past the valve, H, into the 
shower vessel, G. This gives a cold 
shower-bath. To make a warm 
bath, D is a lamp placed under the 
vessel, E, which heats the water, 
when it may be forced up as in the 
COLD SHOWER, WARM SHOWER, AND VAPOR- co i,j e J,ower. 

BATH COMBINED. To make a vapor bath, the pipe, 

M, seen partly in section, is attach- 
ed near the top of the vessel, C, and it has holes at its lower end to let the vapor escape 
into the chamber. When used for a vapor-bath, the piston should be withdrawn, and 
the inside hole in the vessel, C, closed up, when the lamp will generate the steam in a 
short time. The top of the vessel, C, to the tube, E, is made of a funnel shape, as rep- 
resented by B, to allow the water to be easily poured in. I is a faucet to drain off the 
water that may be in the pipe, and there is an attachment to the outside of the valve- 
case, O, to lift the valve, H, to drain off the water above. 

Hot stones or bricks may be used to generate vapor. The patient 
may sit naked on an open-work chair, with a couple of blankets pinned 
around the neck ; a small tub or a common tin pan, holding a quart of 
water, is placed under the chnir, and red-hot bricks or stones occasion- 
ally put into the vessel, so as to keep the vapor constantly rising from 
the surface of the water. 

Another very simple plan is this : Procure a tin boiler of one or two 
gallons measure, with a tin pipe having two or three joints and a single 
elbow. The boiler may be heated on any ordinary fireplace or furnace; 
the pipe can be conducted under a chair or box on which the patient 
may sit, covewl with blankets from the neck downward. The vapor 




WATER-CURE PROCESSES. 39 



or steam may be increased or diminished by regulating the position of 
the boiler over the fire. 

The sweating-cradle (fig. 173) is a convenient apparatus for such in 
valids as are obliged to k 3ep the bed. 




PERSPIRATORY, OR SWEATING-CRADLE. 

Fig. 173 is a drawing of the perspirator, or sweating-cradle, a is a tin or copper bent 
funnel-shaped chimney, with a door, which is seen standing open. The small end of 
this chimney is open. The large end below has a tin bottom, with a hole in it to receive 
the little upright tin saucepan, b; c is the wooden bottom or end of the cradle, with a 
hole in it to receive the small end of the chimney, into which it fits accurately, but 
easily ; d d d d are hoops of wire or wicker ; / is a long, narrow piece of wood, into 
which the ends of the hoops are inserted ; e is a similar piece of wood running along 
the top, and perforated by the hoops. 

When the cradle is to be used, the clothes are to be taken off the bed, and the patient 
is to lie down on his back, with his head on the pillow. The cradle is then to be placed 
over him as high as his throat, its wooden bottom being at the foot of the bed, even with 
the bedstead. It is now to be covered with the whole of the bedclothes, and an addi- 
tional blanket or two. The clothes are to be neatly tucked in every where, so as not to 
let out the heat at any po\nt. But they must not hang down over the wooden bottom, 
and the foot valance of the bed had better be tucked up out of the way. The tin chim- 
ney must be kept clear of all clothes. Every thing having been thus neatly prepared, 
the tin saucepan, 6, is to be filled three-quarters full with alcohol, and the spirit is to be 
Bet on fire. Then, taking hold of the long, straight handle of the saucepan, it is to be 
carefully let down through the hole in the bottom of the chimney, and the door closed. 

The Wave-Bath. — This process consists merely in extending the 
body at length in a swift current of water, the patient holding on to a 
rope, or some other contrivance, to enable him to keep his position. It 
helps to make an amusing variety in the watery part of our materia 
medica. but has no other advantage not obtainable by the douche and 
plunge. 

The Rivef.-Bath. — This amounts practically to an out-door, cold, 



40 THEORY AND PRACTICE. 

or tepji plunge-bath, according to the temperature of the water. In- 
valids should not, as a general rule, bathe in the rivers more than from 
ten to twenty minutes, when the water is tepid ; at all events they 
should avoid great fatigue and the second chill. When the water is 
cold the time must be correspondingly diminished. 

The Rain-Bath. — At some of the water-cures, patients have 
amused themselves with rain-water bathing whenever the propitious 
clouds have furnished the requisite shower. For those who are able 
to walk rapidly a mile or two, a rain-bath is excellent. The constant 
evaporation from the surface and the active exercise effect a rapid 
"change of matter;" and the process seems to combine the virtues of 
the wet-sheet pack and the dripping sheet in an efficacious manner. 
It is scarcely necessary to add that the patient should be dressed in 
light, thin clothes during the walk, and on returning to his room be well 
rubbed with the dry sheet, and keep up moderate exercise for half an 
hour or so after dressing. 

Fountain or Sprat -Bath. — This is a modification of the shower 
or douche-bath, or rather a combination of both. It consists of a num- 
ber of small streams thrown oft' laterally, and diverging as they recede 
from the fountain. It makes a pleasant and very excellent application 
to the chest and abdomen, in affections of the viscera of those cavities, 
when, the stronger impression of the douche cannot be borne, or is not 
indicated. Dyspeptics and consumptives can generally employ it 
more or less to advantage. It is a good process in pleurodynia, or pain 
in the side, in lumbago and neuralgia, and in partial palsy or extreme 
debility of the muscles of any part. Applied to the pelvic region, 
it is well adapted to excite functional action in Rtonic states of the 
organs, amenorrhea, chlorosis, constipation, suppression or retention of 
urine, etc. 

Portable Shower-Bath.— This is a modification of affusion, the 
water being showered instead of poured over the body, and in effect 
it amounts to precisely the same thing as the ordinary process of affu- 
sion. Convenient machines, holding two quarts or more, for shower- 
ing by hand, are made by most of the tinsmiths. 

The Affusion-Bath. — Pouring water over the neck, chest, and 
shoulders, tht natient standing in a tub when it is desirable not to wet 
the floor, is cal d affusion. It is as good as any other form of bath 
where its indication is simply to cool the body, as in the hot stage of 



WATER-CURE PROCESSES. 41 

fevers and active inflammations. Dr. Carrie employed affusions ex- 
tensively, and with remarkable success, in the treatment of scarlet 
fever, measles, small-pox, and other diseases, at Liverpool, England, 
half a century ago ; but, unfortunately, the medical faculty of the 
present day, who acknowledge the superior success of his practice, do 
not see fit to imitate it. Affusions are performed with tepid, cool, or 
cold water, according to the degree of morbid heat attending tlie 
disease. 

Towel or Sponge-Bath. — Washing the whole surface of the 
body with a towel or sponge is a very good prophylactic ; and it may 
be employed in water-treatment as a substitute for various other baths, 
when the requisite apparatuses for the latter are wanting. The pecu- 
liar advantage of this bath is, it can be taken at any time and place, 
whenever and wherever desired. The towel is preferable to tho 
sponge, because its friction is more perfect and uniform. I should be 
unwilling to dress, on rising from bed in the morning, without first rub- 
bing the whole surface with a wet towel, unless some other general 
bath was accessible ; and a towel and quart of water can always be had 
at a hotel or on board a steamboat. Five minutes can never be em- 
ployed in any more profitable way. That parent can hardly be said tc 
" train up a child in the way it should go," who does not instruct it in 
the use of a towel wash, or some other bath, every morning, at all 
seasons of the year. 

Wet-Dress Bath. — This is a modification of the wet sheet, ena- 
bling the patient to dispense with the services of an attendant — a 
mode of self-packing. A linen sheet is fashioned into the form of a 
night-dress, with large sleeves; and after the bed is prepared, tho 
dress can be wet and thrown on ; the patient can then get into bed, and 
wrap himself sufficiently to get a very good warming up. If the bed- 
clothes are not too heavy, nor wrapped too tightly, almost any person, 
not extremely feeble, can remain in this wet dress all night without the 
least injury, shocking as the idea may be to our allopathic friends. 

Warm and Hot Baths. — These are objected to by some German 
hydropaths, as not being Priessnitzian, but for no other reason that T 
can imagine. They are, however, only occasionally employed at the 
American establishments, not being a regular part of any judicious 
course of treatment. But for quieting particular symptoms, and al- 
laying excessive nervous irritability, they fire sometimes eminently ser- 
viceable. In cramps, colic, spasms, and mivulsions, they operate ad- 



42 THEORY AND PRACTICE. 

mirably. It sometimes happens thai a patient, while under treatment, 
will, without any unusual exposure, experience all the symptoms of a 
severe cold, feverisbness, headache, sensitiveness to the atmosphere, 
chilliness, and various aches and pains, All these disagreeable symp- 
toms can generally be removed at once by a hot bath for ten minutes ; 
and if the bath is succeeded by a pail douche, shower or dripping 
sheet, no appreciable debility will result. Patients who have taken 
large quantities of mercury, antimony, or nitre, are peculiarly liable to 
febrile disturbances, and to occasional swellings of the joints and still- 
ness of the muscles, which a warm or hot bath at once relieves. For 
all of the purposes above intimated the bath should be as warm as the 
patient can bear without discomfort; a temperature that is warm to 
3ne may be hot to another ; the proper temperature ranges from 90° 
to 110°. 

The Swimming-Bath. — The exercise of swimming is eminently 
health-preserving, and might with propriety have been treated of in our 
hygienic department; but as it is also eminently therapeutic in some 
forms of chronic disease, the subject is not inappropriate here. For 
that large class of invalids who are consumptive from feeble lungs and 
contracted chests, and for a still larger class of dyspeptics, who are 
costive from torpid or contracted abdominal muscles, there is no better 
exercise than tliat of swimming. All persons, too, whether invalids 
or not, ought to know how to swim, on prudential considerations. 

As all the exercises involved in the various methods of learning to 
swim are just as serviceable to the invalid or well person, as those 
which may be practiced after the art is acquired, and for the purpose 
of enabling the inmates of hydropathic establishments, where suitable 
streams or ponds of water can be found, to do themselves two services 
at once, I copy from one of Fowlers and Wells' publications the fol- 
lowing illustrations : 

Various supports may be re- 
lg- ' sorted to while the learner is 

getting accustomed to the n'e- 
z=-_ cessary motions. Corks and 
bladders are convenient. Fig. 




174 represents a bladder, well 
blown, and fastened over the 
ghoulders by a rope passed un- 
der the chest. Large pieces 
of cork may be attached to 
each end of a rope and used for tl-s samo purpose. The supports 



SWIMMING WITH A BLADDKIl. 



WATER-CURE PROCESSES. 



43 




SWIMMING WITH THE PLANK. 



must always be carefully secured near the shoulders, for, should they 
slip down, they would plunge the head under water. 

Swimming with the plank (fig. 175) has two advantages. The young 
bather has always the means of „. .__ 

saving himself from the effects 
of a sudden cramp, and he can 
practice with facility the neces- 
sary motions with the legs and 
feet, aided by the momentum 
of the plank. A piece of light 
wood, three or four feet long, 
two feet wide, and about two 
inches thick, will answer very well for this purpose. The chin may 
be rested upon the end, and the arms used, but this must be done 
carefully, or the support may go beyond the young swimmer's reach. 

The rope (fig. 176) is another artificial support, which has its ad- 
vantages. A rope may 
be attached to a pole, fas- 
tened — and mind that it 
be well fastened — in the 
bank, or it may be at- 
tached, as shown in the 
engraving, to the branch 
of an overhanging tree. 
Taken in the hands, the 
swimmer may practice 
with his legs, or by hold- 
ing it in his teeth, he may 
use all his limbs at once. 




SWIMMING WITH THE ROPE. 



The rope, however, is not so good as the plank, as it allows of less 
freedom of motion, and the latter might easily be so fixed as to be laid 
hold of by the teeth, and held securely. 

Wherever a descending grade can be found, the learner can soon 
become a good swimmer, with no artificial assistance, by wading in the 
water up to the neck, and then paddling to the shore. 

In swimming, the feet should be about two feet below the surface. 
The hands should be placed just in front of the breast, pointing for- 
ward, the fingers kept close together, and the thumb to the fingers, so 
ns to form a slightly hollow paddle. Now strike the hands forward as 
far as possible, but not bringing them to the surface ; then make a 
sweep backward to the hips, the hands being turned downward and 
outward; then bring them back under the body, and with as little re- 



<4 



THEORV AND PEACTICE. 



sistance as may be, to their former position, and continue as before. 
The hands have three motions — First, from their position at the breast, 
they are pushed straight forward; second, the sweep round to tho 
hips, like an oar, the closed and hollowed hands being the paddle por- 
tion, and their position in the water and descent serving both to propel 
and sustain the body; and,* third, they are brought back under the 
body to the first position. 

Having learned these motions by practicing them slowly, the pupi, 
should proceed to learn the still more important motions of the legs. 
These are likewise three in number : one of preparation, and two of 
propulsion. First, the legs are drawn up as far as possible, by bending 
the knees, and keeping the feet widely separated; second, they are 
pushed with force backward and outward, so that they spread as far as 
possible ; and, third, the legs are brought together, thus acting power- 
fully upon the wedge of water which they inclosed. 

Some works upon swimming advise that the propelling stroke of the 
arms and legs should be used alternately ; but this is not the method 
used by good swimmers, or by that best of teachers, the frog, of whom 
I would advise all new beginners to take lessons. It is better that the 
feet should be brought up at the same time that the hands are carried 
to their first position ; the propelling strokes may then be combined so 
as to give the body its most powerful impetus, as a boat is rowed best 
with simultaneous strokes. 

The motion in the water should be as straight forward as possible, 
and the more the head is immersed the easier is the swimming. Ris- 
ing at every stroke — breasting, as it is called — is both tiresome and 
inelegant. 

All these movements should be made with slowness, and deliberately, 
without the least flurry. The learner will soon breathe naturally, and 
sis the motions are really natural, he will not be long in acquiring them. 
[f ho draw in his breath as ho rises, and breathe it out as he sinks, he 



Fig. 177. 




PLUNGING OR DIVING. 



will time his strokes, and avoid 
swallowing water. Those who 
have been accustomed to fresh 
water must be particularly care- 
ful when they go into the sea, 
the water of which is very 
nauseous. 

In leaping into tho water 
feet first, which is done from 
rocks, bridges, and even from 
the yards and masts of lofty 



WATER -CURE PRO J ESSES. 



45 



Fig. 178. 



vessels, the feet must be kept close together, and the arms either held 
close to the side, or over the head. In diving head foremost, the 
hands must be put together, as in the engraving (fig. 177), so as to di- 
vide the water before the head. The hands are also in the proper 
position for striking out. 

Treading the water (fig. 178) is a favorite position, and useful as a 
means of resting in swimming long 
distances. The position is perpen- 
dicular ; the hands are placed upon 
the hips, as in the vignette, or kept 
close to the side, to assist in balanc- 
ing the body, being moved like fins 
at the wrist only. The feet are 
pushed down alternately, so as to 
support the head above water ; and 
the body may be raised in this way 
to a considerable extent. While in 
this position, if the head be thrown 
back, so as to bring the nose and mouth uppermost, and the chest 
somewhat inflated, the swimmer may sink till his head is nearly cov- 
ered, and remain for any length of time in this position without motion, 
taking care to breathe very slowly. 




TREADING WATER. 




SIDE SWIMMING. 



In swimming on either side (fig. 179), the motions of the legs have 
no alteration, but are performed as Fi „ 179 

usual. To swim on the left side, 
lower that side, which is done with 
the slightest effort, and requires no 
instructions. Then strike forward 
with the left hand, and sideways 
with the right, keeping the back 
of the latter to the front, with the 
thumb side downward, so as to act 
us an oar. In turning on the other side, strike out with the right hand, 
and use the left for an oar. To swim on each side alternately, stretch 
out the lower arm the instant that a strike is made by the feet, and 
strike with the other arm on a level with the head at the instant that 
the feet are urging the swimmer forward; and while the upper hand 
is carried forward, and the feet are contracted, the lower hand must 
be drawn toward the body. This method is full of variety, and capa- 
ble of great rapidity, but it is also very fatiguing. 

Thrusting (fig. 180") is a beautiful variety of this exercise, and much 
used by accomplished swimmers. The legs and feet are worked as 



40 



THEORY AND PRACTICE. 




THRUSTING 



in ordinary swimming, but the hands and arms very ditTerently. One 
g arm, say the right, should 

be lifted wholly out of the 
water, thrust forward to its 
jr. utmost reaching, and then 
dropped upon the water 
with the hand hollowed, 
and then brought back by 
a powerful movement, pull- 
ing the water toward the opposite armpit. At the same time the body- 
must be sustained and steadied by the left hand, working in a small 
circle, and as the right arm comes back from its far reach to the arm- 
pit, the left is carrying in an easy sweep from the breast to the hip. 
The left arm is thrust forward alternately with the right, and by these 
varied movements great rapidity is combined with much ease. 

Swimming on the back (fig. 181) is the easiest of all modes of swim- 
ming, because in this way a larger 
portion of the body is supported 
by the water. It is very useful to 
rest the swimmer from the greater 
exertion of more rapid methods, 
and especially when a long con- 
tinuance in deep water is unavoid- 
able. The swimmer can turn 
swimming on the back. easily to this position, or if learn- 

ing, he has but to incline slowly backward, keeping his head on a linn 
with his body, and letting his ears sink below the surface. Then 
placing his hands upon his hips, he can push himself along with his 
feet and legs with perfect ease and considerable rapidity. 

The hands may be used to assist in propelling in this mode, by bring- 
ing them up edgewise toward the armpits, and then pushing them 
down, the fingers fronting inward, and the thumb part down. This ia 
called "winging." 

The hands may be used at discretion, the application of force in one 
direction, of course, giving motion in the other ; and the best methods 
Fig. 182. al '° soon learned when onco 

the pupil has acquired con- 
fidence in his buoyant pow- 
ers. 

Floating (fig. 182) is so 
useful a part of the art of 
swimming, that it cannot be 





WATER-. 'URE PROCESSES. 47 

too soon obtained. In salt water, nothing is easier ; and in fresh, to 
most persons, it requires but the slightest exertion. The feet should 
be stretched out, and the arms extended upward, so as to be at least 
as higli as the top of the head, and under water. The head must be 
held back, the chin raised, and the chest expanded. The hands will 
easily keep the body in this horizontal position, and by breathing care- 
fully a person may float at ease for hours. Could a person, unable to 
swim, but have the presence of mind to take this position, he could 
scarcely drown. . ..*■ 

To beat the water, the legs are raised out of it alternately while 
swimming on the back, the body being sustained by the hands. 

While swimming on the breast, one leg may be carried backward, 
and taken hold of by the opposite hand, and the swimming continued 
with the leg and hand kept unemployed. This is said to be usefui 
when taken with the cramp in one leg. 

Sioimming under water should be done with the eyes open. If you 
would swim midway between the bottom and the surface, make the 
strokes of the arms and the hands inward, i.e., toward you, as if you 
would embrace the water by large armfuls, keeping the thumbs turned 
rather downward. These are most important manoeuvres. You fire thus 
enabled to pass unseen across a river or branch of water, or to search 
for any thing which has fallen to the bottom, and also to rescue any 
one who is drowning. Beating, and swimming under water should not 
be attempted until the swimmer becomes expert in the other processes. 

Eye and Ear Baths. — Various contrivances have been employed 
to bring the bathing processes to bear on the eyes and ears more pow- 
erfully than by means of wet cloths. The best are ascending, or ob- 
liquely ascending douches or showers. The force should always be 
moderate, but may be applied for a considerable time. They are 
useful in chronic inflammation, unattended with much pain or intoler- 
ance of light, partial blindness or deafness from torpor of the nerves or 
obstruction of the vessels, weakness of vision without preternatural 
sensibility, specs, incipient amaurosis, ;atheri \g in the ears, etc. 

The Nasal-Bath. — Sniffing water up the nostrils, or drawing it 
so far into the nasal cavities as to be ejected by the mouth, is very 
useful in chronic inflammation, and in a relaxed or weakened state of 
the mucous membrane of the nose. In common colds, and catarrhal af- 
fections, the process is salutary. For debility, relaxation, or dryness of 
the mucous membrane from tke use of snuff, it may be employed 
perseveringly to advantage. For nose-bleeding, the water should bo 



THEORY AND PRACTICE. 



as cold as possible. After the removal of soft polypi from the nostrils, 
iced-water should be employed frequently to constringe the vessels. 
In employing the nasal-bath, the water should be taken up by gentle, 
full inspirations, not by a sudden jerking motion, as this often gives 
pain and increases irritation. 

The Oral, or Mouth-Bath. — Gargling the mouth with pure 
cold water should not be omitted in inflammatory affections of the 
throat or palate. For sore or swelled gums, toothache, hoarseness, 
and all vitiated secretions, cool or cold water should be frequently held 
in the mouth until it becomes warm, and often repeated. In apthous 
or cankerous affections of the mouh, water should be employed in the 
same way. Relaxation or falling of the uvula, or soft palate, can gen- 
erally be relieved or cured by gargling perseveringly with the coldest 
water, or by holding lumps of ice in the mouth. Tobacco-chewers 
should first abandon the filthy habit, and then employ the cold mouth- 
bath to restore the natural sensibility of the mucous membrane, and a 
healthful secretion of saliva. 

The Arm-Bath. — For old ulcers, and recent or chronic swellings 
of any part of the arm, holding the affected part in cold water from 
fifteen minutes to an hour, will greatly .assist in healing the ulcer or 
Absorbing the swelling. Eruptive and rheumatic affections, in fact, all 
morbid conditions of the upper extremities, attended with preternat- 
ural heat, should be treated locally, by holding the part diseased in 
cool or cold water, or wrapping it in wet cloths, to be frequently 
changed, until the temperature becomes natural. In erratic complaints, 
which are liable to change the seat of inflammation, as with gout, 
iheumatism, especially mercurial rheumatism, care should be taken to 
discontinue the cold application as soon as the morbid heat is thoroughly 
subdued. When cold applications increase the pain, warm or hot may 
be substituted. 

The Hand-Bath. — Habitual coldness of the hands, or numbness, 
is relieved by holding them frequently in very cold water, rubbing 
them smartly at the same time. Warty excrescences are often cured 
by chilling tho hands severely by holding them a long time in the cold- 
est water. 

The Finger-Bath. — This is employed for felons or whitlows, and 
other similar affections. Tho temperature of the water should, in all 
cases, be that which feels most agreeable, during its application 



WATER-CURE PROCESSES. 49 

The Leg-Bath. — The lower limbs are much more liable to chronic 
swellings, ulcers, gouty and rheumatic enlargements, etc., than the 
upper, on account of the adverse relation of the force of gravitation to 
the weakened vessels. The knee-joint is occasionally affected with a 
chronic inflammation of its membranes — synovitis— -for which the leg- 
bath is serviceable. A tin vessel, shaped something like a boot, large 
and long enough to take in the leg above the knee, is a convenient 
means of administering this bath. If the patient is crippled, an India- 
rubber bag, constructed with straps, by which it may be hung upon a 
chair, or fastened to the side of the bed, is more convenient. It may 
be employed from fifteen minutes to one hour. There is no danger 
of producing metastases, or driving the disease to internal parts, in 
any form of rheumatic or gouty inflammation, provided the application 
is not continued beyond the point of reducing the temperature to the 
natural standard. 

The Drot-Bath. — This process is not often resorted to, nor is it 
even mentioned in some hydropathic books. Still it is sometimes ser- 
viceable, and ought to be understood. Wiess gives the best description 
of it : 

" This term is applied to single drops of water falling from a height 
of several fathoms. A vessel is filled with very cold water, and fur- 
nished with a small aperture, through which the water passes in the 
form of drops. The small aperture should be partially closed by a 
plug, to prevent the drops from following each other in rapid succession. 
By these means their operation is considerably increased, and it be- 
comes yet more potent if we allow the drops to fall upon a particular 
part at certain periods, and rub the part during the intervals. The 
reaction about to commence will indeed be thus interrupted, but will 
afterward make its appearance in a more powerful and energetic form. 

"The violent excitement and irritation of the nervous system pro- 
duced by these baths, render it necessary to restrict the use of them 
to half an hour; nor are they, indeed, adapted for vital parts, or such 
as are abundantly supplied with nerves. 

"They are often used with more effect in obstinate and chronic cases 
of paralysis than the douche or affusion, with which they may alternate. 
Powerful and continued friction with a horse-hair glove is never in this 
case to be neglected after the baths." 

The Air-Bath. — This is not quite a water-cure process, but as air, 
as well as water, in all its adaptations to health-producing purposes, 
belongs to the Water-Cure system, the air-bath may be properly con- 
II— 5 



60 THEORY AND PRACTICE. 

sidered in this place. If consists of the sudden exposure of the whole 
body, in a state of nudity, to cool or cold air, or even a strong current. 
It is employed under precisely the same regulations as a cold-water 
bath. It is certainly a very invigorating process, and may always be 
safely applied to the whole body when the body is in a sensible glow 
or when the temperature is above the natural standard, and generally, 
also, when the temperature is at the natural standard, provided there 
is no sensalion of chilliness present. It is useful, moreover, to exposa 
any painful or inflamed part to cold air, at any time when the sensation 
of cold is agreeable. The air-bath has sometimes followed the wet- 
pack, the same friction, exercise, etc., being employed to keep up 
comfortable reaction after it. 

Sitting naked in a cold room for from ten minutes to an hour has 
been practiced by some persons as a hygienic measure. There are 
few persons who cannot bear a moderate degree of such exposure to 
advantage. Those of feeble circulation would do better to walk, jump, 
dance, or exercise in some other way. Franklin, whose practical 
sagacity and keen observation have attained a world-wide celebrity, 
accustomed himself to sit and read half an hour or an hour, on rising 
in I he morning, before dressing. 

Walking the room in a state of entire nudity, has been resorted to 
for the purpose of promoting sleep in very restless, dream-disturbed 
individuals, and it is said to conduce remarkably to quiet and refreshing 
sleep. 1 have known the experiment tried frequently, and always with 
good effect. 

Patients suffering irom fevers and inflammatory disorders, under the 
popular practice, generally have their sufferings greatly aggravated by 
too much bed-clothing. From a vague apprehension of catching cold 
they are half stifled with excess of heat. There is no danger what- 
ever of cold a>r in any quantity or degree in such cases, so W as the 
whole surface is preteinaturally hot 

FoMKiVTATtoNs—Warm and hot fomentations are useful in a variety 
of morbid cond.Uons. They are sedative and relaxant, and are nnpro- 
prmte m cases of spasmodic pains, muscular contractions, periodical 
headaches, hysterical convulsions, etc.. when, the state of the system 
« net actively inflammatory, nor the local part preternaturally hot In 
the latter case, cold applications are the most efficacious to alleviate 
PH>» or cramps. A very good and perfectly safe rule for all p X,l 
purposes, ,n the selection of cold, cool, warm, or hot .oca, appf t o 
is the sensntums of the patient. That temperature which feel T« 
best . the best. This rule will app.y to cramps, spasms, '^00^ 



WATEE-2URE PROCESSES. 6} 

ache, backache, erratic and irregular pains from various chronic dis- 
eases, lumbago, pleurodynia, etc. 

But it must be recollected that all very warm or hot applications are 
always for occasional, never for constant employment. They are to 
be regarded in every case as temporary expedients, spec-ally intended 
to quiet pain, subdue local irritation, and remove irregular muscular 
contractions, or as adjuvants to the general curative course; and rightly 
managed with this view, they are highly important as well as pleasant 
resources. They produce temporary relaxation, but no permanent 
debility when used in connection with more or less cold bathing, as 
would be the case were they employed alone. 

The French method of hot fomentations, so highly commended by 
Dr. Gully, is as efficacious and perhaps more convenient than any other 
in use : A piece of flannel thrice-folded is put into a dry basin, and 
very hot water poured on it, sufficiently to soak it. The flannel is then 
put into the corner of a towel, which is twisted round it, and wrung 
until the flannel is only damp. It is taken out of the towel, and imme- 
diately laid over the pail to be fomented, and upon it is placed a double 
fold of thick flannel, dry. o: part of a light blanket. The patient 
then, if it be the abdomen which is fomented, draws the ordinary bed- 
clothes over him, and remains quiet for five or six minutes, when 
another flannel freshly wrung out is applied, the former one being 
withdrawn. 

The cloths seldom require changing more than three or four times. 
Generally relief is obtained in ten or fifteen minutes. I have very 
often witnessed the best effects from this fomentation in nervous and 
dyspeptic headaches, in globus hystericus — the sense of suffocation 
often accompanying hysteria, and in painful menstruation. It is also 
frequently effectual in relieving, for the time, asthmatic fits, convulsions 
from teething or indigestion, neuralgia in the head or face; it will gen- 
erally also produce relaxation of the bladder or bowels, in cases of re- 
tention of urine and severe constipation. In those severe derangements 
of the stomach and liver, attended with excessive nausea, severe 
retching and vomiting, intolerance of food and drink, etc., its use, in 
connection with the pouring of cold water over the back of the head 
and temples, will usually afford prompt relief, as I have many times 
experienced. For all these purposes the fomenting cloth shouJd be 
large enough to cover half or two thirds of the surface of the abdomen. 
There are some delicate invalids, of bloodless skin and feeble vitality, 
who find it extremely difficult to get comfortably warm in the wet 
sheet, and such may be very much assisted by a fomentation to the 
abdomen for five minutes before and after the pack. 



62 THEORY AND PRACTICE. 

Rest, and not exercise, should succeed the application of hot fo- 
mentations, except when they are employed as an auxiliary to and 
followed by a cold bath. 

I have thus far spoken only of hot fomentations to the abdomen; 
and indeed in nine cases out of ten where this process is indicated at 
all, the place and manner described will answer all purposes. Yet in 
various local, spasmodic, or periodical pains they may be applied as near 
the part affected as possible. In affections of less severity, wet cloths 
of any kind, applied as hot as can be borne, will prove sufficient. 

Bandages. — These may be local warming or cooling processes, as 
indicated, and answer all the purposes of the awkward, bungling, and ex- 
pensive machinery of liniments, lotions, poultices, embrocations, blisters, 
rubefacients, epispastics, cuppings, issues, burnings, and other external 
drug appliances of the old school. 

A warming bandage, or compress, is simply one or more folds of linen 
cloth, wet in cold water, applied to the part affected, and covered with 
a dry cloth or other material, to retain the animal heat. 

A cooling bandage, or compress, is a similar wet application without 
the dry covering, or with the covering so light as to .allow the animal 
heat readily to pass off. In both cases the cloth is to be renewed as 
often as it becomes dry. As usually managed, these compresses are 
both cooling and warming, the first impression being cold, and the re- 
action leaving a glow upon the surface; but they can be made to pro- 
duce a constantly cooling effect by very lightly covering and frequently 
changing them, or a very heating effect by covering them with flannel 
or other non-conducting material. 

Coarse linen cloth, as common crash toweling, is the most suitable 
cloth to be wetted ; and for the dry covering, the same material, or 
any common muslin, will answer in warm weather, and soft flannel in 
cold weather. India rubber, gutta percha, and oiled silk have all been 
in repute, and a few years ago were very generally employed for cov- 
erings. I regard them all as objectionable. They do indeed serve to 
prevent evaporation, and retain more peifectly the animal heat, and 
they also keep the part moist longer; and they seem, too, to have n 
more drawing or derivative influence, if the moie ready production of 
eruptions or boils indicates such influence. But they retain the effete 
perspirable matter which should pass off; and their non-conductino-, or 
non-electric property renders them relaxing and weakening to tiuTcu- 
taneous function. 

It seems to me that, in all cases, cloth coverings are the best. If 
they produce a less number of boils or less painful eruptions, the cure 



WATER-CURE PROCESSES. 



will nevertheless be as prompt and even more perfect. When the 
skin is torpid and cold, Canton or soft, light, woolen flanrel answers 
every purpose ; and if necessary, for very feeble patients who are 
unable to take much exercise, two or three thicknesses may be 
used 

The Chest-Wrapper. — This is advantageously employed in nearly 
all chronic diseases of the chest, as incipient consumption, bronchitis, 
in the very early stage of hydroihorax, or dropsy of the chest, spas- 
modic or periodical asthma, etc. It may be made of crash toweling, 
or two or three folds of muslin, and fitted, with arm-holes, loosely to 
the trunk of the body from the neck, nearly or quite down to the hips. 
The outside covering is i similar wrapper, made of the same material, 
or of flannel. The inner, or wet wrapper, is tied as tightly around the 
body as desired by tapes, which are attached to the top, bottom, and 
middle, and the outside or dry wrapper is either tied around it, or the 
nner one is buttoned to the outer. 

There is some discrepancy in the views of different hydropaths, as 
to whether the wet cloth should extend entirely around the body, or a 
few inches over the spine be left uncovered. Here again, as in most 
of the vexed questions which occur in hydropathic bathing, the feelings 
of the patient are our best guide. If the wet cloth over the s.pine does 
not produce any disagreeable chilliness, pain, or uneasiness, different 
from what i3 experienced when the partial wrapper is worn, I would 
have it entirely encircle the trunk ; otherwise a space of from four to 
six inches in the center of the back should be uncovered by the wet 
cloth. 

This may be worn day and night for several weeks, provided it pro- 
duces no uncomfortable chilliness during the day, and does not become 
so warm and dry as to make the patient restless during the night. In 
the former case it should only be worn during the warmest part of the 
day, or during the time allotted to exercise, or from the morning bath 
until noon, or from the forenoon bath until evening. In the latter case 
it may be worn during the day, and omitted at night. It usually re- 
quires wetting when worn constantly, in the morning, toward noon, 
toward evening, and at bedtime. 

The Abdominal Wrapper. — The wet girdle, or abdominal com- 
press, as this is generally called, is more generally employed than any 
other local hydropathic application. Derangements of the digestive 
organs are so prevalent nowadays that those who do not thus complain 
are exceptions ti the general rule and for all of these complaints thia 



THEORY AND PRACTICE. 



bandage is appropriate. It is also serviceable in all chronic diseases of 
the liver, and in acu e diseases of the abdominal viscera, as inflammation 
of the stomach and bowels, cholera, dysentery, cholera morbus, diarrhea, 
etc., it is always employed w ith benefit. 

A great deal of ingenuity has been wasted in contriving abdominal 
compresses. But the best invention of all is three yards of common 
crash towel cloth. One half of this is wet, and moderately wrung; 
the wet end is applied to the side of the abdomen, then the. bandage is 
passed across the abdomen, and around the body, followed by the dry 
half. This brings two folds of the wet part over the front of the abdo- 
men, and one behind. Whether it is to be extended entirely around 
the body, must be determined by the rule mentioned as applicable to 
the chest-wrapper. The proper crash cloth is from twelve to sixteen 
inches wide, and covers the trunk from the short ribs to the hips, de- 
scending a little over the latter. As with the chest-wrapper, it may 
be worn constantly or occasionally. It should never be applied so 
tightly as to hinder in the least free respiration. It may be kept in 
place by tapes or pins. 

This bandage is employed more or less in all cases of dyspepsia, 
liver complaints, constipation, paralysis of the lower limbs, affection of 
the pancreas, spleen, kidneys, and bladder, obstructions of the mesen- 
teric glands, all forms of mismenstruation and female weakness, in a 
word, in all chronic morbid conditions of the abdominal and pelvic 
viscera, and in all states of weakness or relaxation in their ligaments 
or muscles. Persons who have weakened the abdominal muscles and 
viscera by sedentary habits and crooked bodily positions, experience 
great benefit from its use. 

Friction.— Hand-rubbing, towel-rubbing, rubbing the skin over the 
wet or dry sheet, and with a flesh-brush or horse-hair gloves, are 
among the accompaniments of the bathing processes. Their object is 
to assist reaction and promote capillary circulation. As a general rule, 
patients should practice as much self-rubbing as convenient, at the 
same time that they are assisted by the attendant, because the exercise 
of so doing is an advantage of itself. As a general rule, too, the amount 
of friction in each case should be proportioned to the bloodlessnoss and 
torpor of the skin; and another general rule may be stated in relation 
to friction, which is, that it should be active and rapid, rather than 
harsh or scraping ; rather magnetic than forcible. Some invalids on 
the mistaken notion that the harder they are rubbed the more will 
they become vitally magnetized, leep the attendants at work, if they 
be good-natured, and object not, :ntil completely exhausted'; hence 



WATER-CURE PROCESSES. 55 

the physician should always instruct the attendants well in this partic- 
ular duty. 

Tkmpkrature of Baths.- — Hot, warm, tepid, cool, and cold are 
only employed as approximate terms. Water that feels hot to one 
may be only warm to another, and what is cold to one is sometimes 
tepid to another. The sensations of the patient are generally a bet- 
ter guide for regulating the temperature of a g ven barh than is the 
thermometer; still, the latter is indispensable in many case^, and in all 
convenient. As a general rule, the more feeble and delicate the pa- 
tient, the more strictly should we follow the test of his feelings in ad 
ministering tepid, warm, cool, or cold baths. When the circulation is 
vigorous, and the vital temperament well developed, we may regulate 
any bath with sufficient precision by the thermometer. It is a useful 
precaution, when commencing treatment with very susceptible pa- 
tients, to test their sensibility to different temperatures of water, 
after which the physician or patient can prescribe them thermomet- 
rically. Some Water-Cure books seem to make it an especial point to 
be thermometrically exact in directing particular baths for given dis- 
eases, as for example: sitz-bath, at 59°, shallow-bath, at fi.3°, half-bath, 
nt 74°, etc. These nice distinctions are not to be arbitrarily imitated, 
but may be regarded as landmarks, to keep us within reasonable 
bounds. 

Baths may be distinguished into cold, below G5' Fahr. : tepid, 65° 
to 80° ; warm, 80° to 98° ; and hot, above 98°. But a better division 
may be made thus : 

Very cold, 32° to 40". Tepid, 72° to 85°. 

Cold, 40° to 55°. Warm, 85° to 98°. 

Cool, 55° to 65°. Hot, 98° to 115°. 

Temperate, 65° to 72°. Vapor, 98° to 125°. 

The term moderately tepid, warm, cool, or cold, when occurring in 
this work, means some degree between the bath named and temper- 
ate, or the next bath in the scale, reckoning toward temperate ; thus 
moderately hot would mean a temperature between 98° and 65°, etc. 

Duration of Baths. — There is the same mystical yet unmeaning 
exactness about the time of continuing a given bath, to fulfill a particu- 
lar indication, in many Water-Cure books, that there ie about the tem- 
nerature. But here, again, we have better guides than seconds ani 
•ninutes, in the feelings of the patients and in the effects produced. It 



56 THEORY AND PRACTICE. 

is true an experienced hydropath can, on examining a patient, determ- 
ine at once about the proper length of time to administer most of his 
baths ; but this time should always have a nearer relation to the condi- 
tion of the patient, and the sum total of all the treatment prescribed, 
than to the name of the disease. A general rule may be laid down, 
that all patients should limit all baths to a period short of producing airy 
very depressing chill; and never continue any one to the point of pro- 
ducing a second chill after the reaction has once taken place in the 
bath. In home-treatment the safer way is to incline to frequent and 
short baths, rather than few and long. 

General Rules for Hydropathic Bathing. — 1. No bath should 
be taken on a full stomach. General baths, as the wet-sheet, plunge, 
douche, shower, etc., should not be taken until the process of diges- 
tion is nearly or quite completed — from three to four hours after a full 
meal. Local baths, as the hip, foot, hand, leg, etc., may be taken in 
an hour after a light, and two hours after a hearty meal Bandages 
may be applied at any time. 

2. Patients should not eat immediately after a bath. An hour is 
soon enough after a full, and half an hour after a local bath. 

3. All patients who are able should exercise moderately previous to 
a bath, unless at the bath time the body is already in a warm glow; 
and after a bath, according to muscular strength. The more exercise 
short of absolute fatigue the better. By absolute fatigue I mean that 
degree of exhaustion which is not readily recovered from on resting. 

4. In very warm weather the most active exercise should be taken 
before breakfast; and during the heat of the day it should not be 
crowded beyond what is perfectly agreeable. 

5. No strong shock should ever be made upon the head. A shower 
or pail- douche, poured but not dashed on, is not objectionable for those 
who enjoy a tolerably well-balanced circulation, and are not subject to 
nervous headache. 

6. Profuse perspiration, or great heat of the body, is no objection to 
nny form of cold bath, provided the body is not in a state of exhaustion 
from over-exertion, nor the breathing disturbed. This point is gene- 
rally misunderstood by physicians, and medical books of the old scboo, 
are wholly in error about it. The majority of peopit imagine that the 
sudden transition from cold to hot is dangerous. The danger is all on 
the other side— in applying cold when the body is already too cold. 
Again, it is thought that a cold bath, when the body is dripping with 
sweat, will check the perspiration, and do immense mischief by driving 
it in ! This is. a nrrare phantasy. The matter of perspiration is a 



WATER-CURE PROCESSES. 57 

viscid, waste, dead, effete material, and its presence on the surface has 
nothing whatever to do with the effect of a cold bath. It may be as 
safely washed off with cold water when the body is hot, as can any 
other extraneous matter adherent to the surface. 

But persons are often injured by going into cold water when the 
body is hot and perspirable. Granted. I have known several young 
men made cripples for life by this practice. Now what is the ex- 
planation ? Either the body was too cold, or in a state of exhaustion, 
or the respiration was materially disturbed, or the stomach was loaded, 
or all of these conditions existed together. There is a reciprocal re- 
lation between circulation and respiration, which cannot be greatly 
disturbed without injury. If a person jumps into cold water when out 
of breath from violent exercise, he endangers his health, because the 
intimate sympathy between the action of the heart and lungs will pre- 
vent reaction to the surface, and the result is internal congestion. 
Under all other circumstances, a warm or hot skin is favorable to any 
cold application, while the state of perspiration is a matter of no sort 
of consequence one way or the other. Dr. Johnson remarks : "Being 
in a state of perspiration is no objection to taking any bath, except the 
sit'/,, foot, and head-bath." If the rules I have laid down are duly ob- 
served, there can.be no force in the objection of Dr. Johnson. 

7. When full treatment is prescribed, as three, four, or five baths a 
day, the patient should take the most powerful, or those which produce 
the greatest shock, on rising, and in the early part of the day. 

8. Wetting the head, and even the chest, is a useful precaution be- 
fore taking any full bath, and especially important for patients who are 
liable to head affections. 

Water-Drinking.— The indiscriminate drinking of large quantities 
of water, as has been the custom at some establishments, is not to be 
commended. The amount that can be taken to advantage varies 
greatly according to disease, temperament, exercise, diet, etc. Per- 
sons of large chest and abdomen, of florid complexion and active capil- 
lary circulation, can drink with satisfaction, and require, while under 
treatment, a free use of water as drink — from twelve to twenty tum- 
blers. On the contrary, those of thin, spare body, nervous tempera- 
ment, and especially if the skin appears bilious, and the pores, as it 
were, glued together, cannot take, with profit, more than three to 6ix 
tumblers daily. In the former case the water is rapidly absorbed from 
the stomach, and thrown off by the skin ; in the latter case it lies, as 
it were, like a dead weight in the first passages, and is finally carried 
■>ff mainly by the kidneys. 



58 THEORY AND PRACTICE. 

Considerable allowance must- also be made for the amount of exer- 
cise the patient can take, and the kind of food partaken of. The 
greater the amount of exercise, the more cutaneous transpiration, and 
the more water required. Those who use much animal food, salt, or 
other seasonings, grease of any kind, or concentrated farinaceous food, 
require a much larger quantity of water — other circumstances being 
equal, than those who restrict themselves to a plain vegetable diet. 
Patients should always drink to the extent of thirst ; but for a general 
rule while under treatment, water should be taken most freely early 
in the morning, after the bath, and again about the middle of the fore- 
noon ; a less quantity still in the afternoon, and little or none in the 
evening. Very little should be drank at meals. 

There are some few dyspeptics whose stomachs are so contracted 
and sensitive, whose livers are so torpid, and whose capillary circula- 
tion so diminished, that even a single tumbler of cold water produces a 
painful heaviness and distressing chilliness of the stomach. Such in- 
valids should begin with half a tumbler, or even less, and gradually but 
carefully increase the quantity, as it can be borne without producing 
unpleasant sensations. In such cases, too, the water drank should never 
be very cold ; the best temperature is from 55° to 65 u . 

Drs. Gully, Johnson, Wilson, and Rausse, very severely and very 
justly repudiate the indiscriminate practice of large water-drinking, 
which is so highly and extravagantly recommended in some works on 
Water-Cure. I have seen no{ a little mischief result from it ; in home 
practice water-drinking is particularly liable to be overdone. Some 
persons have boasted of the "ravenous appetite" produced by drinking 
twenty or thirty tumblers of water a day; but I cannot understand the 
advantage of ravenous appetites ; they are generally indicative of ex- 
cessive morbid irritation in the stomach. 

The rule for those who have not an intelligent hydropath to advise 
with, is to follow the sensations of the stomach ; take all that produces 
pleasurable sensations, and no more. More or less water should always 
be taken after each bath. Exercise should succeed water-drinking, 
and, as already intimated, it should be proportioned to the amount of 
water taken. 

Lavements and Injections.— These are used as cleansing and 
relaxing, or tonic and contracting processes. For the former purposes 
tepid or warm water is employed, and for the latter cool or cold. On 
the first attack of acute diseases of the bowels, cholera, dysentery 
colic, diarrhea, etc., copious tepii injections should be promptly resort- 
P d to. und succeeded, aftei the alimentary canal is well cleansed 07 



CRISES. 69 

cool injections. In obstinate constipation from debility, cold injections 
should be employed daily until general treatment and diet can repro- 
duce the ordinary peristaltic action. In hemorrhoids an injection of a 
small quantity of cold water just previous to the expected movement of 
the bowels, greatly assists the healing process. Chronic diarrhea gen- 
erally requires cool or cold injections occasionally. In all chronic mu- 
cous or muco-purulent discharges from the bowels, bladder, urethra, 
or vagina, injections of a temperature suited to the susceptibility of the 
part affected, or the degree of inflammation, are an indispensable part 
of the treatment* In gleel, leucorrhea, prolapsus, and menorrhagia, they 
should be freely used as strengthening processes. After parturition 
the vagina should be cleansed with a cool injection. The most conve- 
nient instrument for self-treatment is the pump syringe for the bowels. 
The curved tube vaginal syringe is indispensable for females. In some 
affections of the uterus and vagina, a small tube speculum is necessary 
to be introduced to enable the water to come in contact with as large a 
surface as possible while employing the sitz-bath. The Union India 
Rubber Company, of this city (office 19 Nassau Street), has just 
brought out an admirable apparatus for throwing water up the rectum 
or vagina with any degree of force required. It consists of a bag, 
holding a gallon or more, which is filled with water and elevated, by 
hanging on a hook or nail, six, eight, or ten feet. The force of the 
stream is regulated by pressure on a long tube which conveys the water 
from the bag or fountain ; and to the end of this tube suitable pipes are 
adjusted to convey the water up the vaginal or intestinal passage. This 
apparatus is cheap and not liable to get out of order. 



CHAPTER III. 



Doctrinf. of Crisis. — The doctrine of crisis is as ancient as Hip- 
pocrates. Acute diseases, when left to themselves, often terminate by 
some spontaneous evacuation ; and chronic diseases, when left to the 
unaided remedial powers of nature, are frequently resolved by some 
external eruption or internal abscess. Under water-treatment, acute 
diseases are generally relieved by mild yet effectual functional efforts 
pf all the excretory organs, unattended with any great commotion in 



60 THEORY AND PRACTICE. 

the organism, or strong determination to any jne envmctory, or sinn- 
ing of the vit-al powers, which can be called in any sense critical. 

But with chronic diseases the case is often very different. Many 
cases, indeed, recover without any disturbance which can properly be 
denominated a crisis ; others recover after repeated disturbances, more 
or less severe, which may be called critical efforts ; and others, after 
one or several paroxysms of general or local excitement, attended with 
some profuse evacuation, severe boils or eruptions, a general feverish- 
ness, or an aggravation of old, half-forgotten aehes, pains, or other local 
affections. 

Forms of Crises. — The most common forms in wnich crises, or 
critical efforts, present themselves are, diarrhea, boils, and general 
feverishness. Boils present all manner of appearances from the hard, 
diffused, inflammatory swelling, with scarcely any suppurating point, 
to the deep, fully-matured, sub-cutaneous abscess ; there may be one 
or several at the same time, or they may succeed each other for weeks 
or months, and be very painful, or scarcely troublesome. Those of 
full habit, sanguine temperament, and active external circulation, are 
most subject to boils and eruptions. 

Diarrheas, when purely critical, come on without any accidental or 
unusual exposure or dietetic error, and continue with greater or less se- 
verity from three days to two weeks. There is not usually much pain, 
griping, or distress of any kind in the bowels, but the evacuations are 
thin, wateiy, and frequent ; generally there are from three to six or 
eight motions in twenty hours. In persons who have been most sub- 
ject to piles, the motions will be most frequent, and attended with con- 
siderable bearing down or dragging sensation about the lower bowel, 
and the discharges will exhibit a great amount of mucous or slimy mat- 
ter, often intermixed with blood. A critical looseness of the bowels is 
not attended with debility like an ordinary diarrhea ; if long contin- 
ued, there is, of course, some degree of languor, but then the dis- 
charges are very easily checked by hot sitz-baths and cold injections. 
Those who have long 'abored under derangements of the digestive or- 
gans, and particularly those with torpid livers and constipated bowels ; 
more especially, if these conditions are complicated with pale, yellow, 
bloodless skin, and shriveled, superficial, capillary vessels, are most lia- 
ble to critical evacuations by the bowels ; and, as far as my observa- 
tion extends, they are iu 'ariably beneficial, always being succeeded by 
a decided sense of improvement in the patient's entire physiological 
condition. 

The term " feverishness," does not very well express the other com- 



CRISES. 61 

mon form of critical action, but I know of no better one to employ. It, 
is characterized by more or less of the symptoms which attend an at- 
tack of simple fever, but they appear in a more disguised and irregular 
form. There is chilliness and heat, languor, depression, backache, 
headache, general restlessness, great sensitiveness to cold, etc., etc., 
but, unlike the same symptoms in a paroxysm of simple fever, they do 
not follow each other in the order of the cold, hot, and sweating stages. 
This febrile disturbance continues from one day to a week, when, un- 
less aggravated by improper treatment, the body recovers its balance of 
action and feeling, and the patient feels himself advanced at least one 
step on the road to health. Other manifestations of critical disturb- 
ance, as eruptions, rashes, profuse sweatings, copious discharge of 
urine, vomitings, free evacuation of bile, etc., stiffness of the muscles, 
pain and swelling of gouty aud rheumatic joints, fetid perspirations, 
where compresses are worn, etc., occasionally occur, but require no 
especial management save moderating or suspending a part or all of 
the cold treatment, as the general disturbance of the system is more or 
less violent, and employing soothing applications, as indicated. 

Management of Crises. — The management of crises is not diffi- 
cult ; generally all that is required is an omission of some part or all of 
the stronger baths, according to the violence of the crisis, and the use 
of such mild and soothing appliances as are most agreeable to the pa- 
tient. The patient should exercise or rest, as he finds either most 
comfortable, diet very simply, and use water locally to boils, eruptive 
or inflamed parts — of the temperature that feels most pleasant. If 
there is violent headache, it may be soothed with the hot abdominal fo- 
mentations. If the whole body is sore, tender, restless, and irritable, 
a hot, bath should be taken for ten minutes ; and if diarrhea progress- 
es so far as to materially weaken the patient, the hot fomentation, or 
hot sitz-bath, with cold injections, should be employed. Full treat- 
ment should not be resumed until the critical disturbance is entirely 
abated. 

Rationale or Crisis. — I do not know that it is possible to explain 
satisfactorily to the professional or non-professional reader the true ra- 
tionale of critical action, since all the language employed in relation to 
vital laws, organic instincts, remedial actions, etc., is necessarily more 
or less figurative. Authors on Water-Cure all agree that crises do oc- 
cur; some regard them as of general occurrence, the cures without 
such phenomena being exceptions to a genera] rule ; others con^eno" 
that cures can generally be made without crises, these being the ex- 
6 



62 THEORY AND PRACTICE. 

ceptious ; and still others regard the majority of the crises as the re- 
sult of injudicious or excessive treatment. 

It is perfectly certain that many bad cases of chronic disease are 
cured without any appearance of crises whatever; it is equally certain, 
in my judgment, that some few cases are utterly incurable without the 
production of a decided crisis; and I am full} convinced that in many 
cases crises are rendered unnecessarily and even dangerously severe 
by excessive or injudicious treatment— generally too cold or too shock- 
ing treatment. If a patient is kept continuously chilled, so [hat com- 
fortable reaction does not take place between the baths, or the douche 
is applied so severely as to produce a state of unusual nervousness, the 
crises will be very apt to bo injuriously violent. Hence the safer gen- 
eral plan of treatment, especially in home practice, is to take the slower 
yet surer way — do only what is clearly proper, and keep always on the 
safe side. In this way we only lose a little time, for which life or 
health should never be periled. 

The diet has an important bearing on the severity of the crisis. In 
all cases, the more plain, simple, and strictly physiological is the food 
taken, the less severe and distressing will be the critical efforts ; all 
gross, greasy, high-seasoned food, or complicated dishes render a se- 
vere treatment necessary to cure, and this necessarily involves a more 
violent crisis. It is a great error on the part of some physicians to al- 
low a hotel table, and then depend on harsher water processes to ef- 
fect the cure ; the blame, however, is not all on the side of the physi- 
cians, for many patients prefer to " eat what their souls lust after," and 
take the harder treatment, greater suffering, and less perfect cure. 

Doctor J. Weiss says {Hand-Book of Hydropathy) : "This natural 
vital process is not to be regarded as morbid, for, with the existing dis- 
ease, it has nothing in common. While a disease lasts, therefore, no 
crisis can ensue. The appearance of the crisis announces a return of 
the vessels in the diseased parts to their normal activity, the resump- 
tion of the proper functions assigned to them ; or, in other words, the 
emancipation of the organism or its organs from disease. This is the 
sole signification of the crisis, according to experience and nature." 

Doctor E. Johnson remarks : "That the system, by virtue of its own 
inherent energies, sometimes purges itself of morbid matters by a 
crisis; that is, by establishing some temporary outlet through which 
such morbid matters may and do escape, is perfectly certain. The 
Aleppo boil, small-pox, measles, and many other well-known diseases 
prove this to demonstration, and beyond the possibility of question. In 
all these cases the crisis is clearly the means of cure. Without such "or 
some similar crisis, the patient must die- Whether the water-treat? 



CRISES 63 

ment has the power of urging nature to the establishment of such 
temporary outlets is another question, to which I can only reply, that I 
believe it has." 

Doctor Gully remarks (Water-Cure in Chronic Diseases): "In the 
course of the efforts which nature makes, with the co-operation of the 
Water-Cure, it sometimes happens that the new distribution of blood 
which they bring about is so energetically affected as to cause morbid 
congestions of blood in other organs than the diseased viscera. In this 
manner congestion of the lower bowel takes place, and is exhibited in 
diarrhea ; general congestion of the skin takes place, and is exhibited 
in sweats of various kinds ; or partial but more intense congestions of 
the skin take place, and are exhibited in eruptions of various kinds, 
and in boils of various degrees. To these exhibitions of transferred ir- 
ritation and circulation the name of crisis is given. * * * Critical ac- 
tion, then, as a result of the water-treatment, signifies that the viscera 
have been enabled to throw their irritation and blood upon some other 
organs, the lower bowels, or skin ; and that this excess of blood, and 
this irritative action attempts relief by throwing out large focal secre- 
tion, or unusual cutaneous secretion. This is all that can be said of a 
crisis; it is an outward and visible sign of the exercise of a power on the 
part of the inward organs to save themselves by a transfer of mischief 
to parts less essential to life." 

Doctor Shew observes (Water-Cure Manual): "A crisis may be 
said to be a visible effort on the part of nature or the natural powers of 
the system, to rid it of some morbid matter or matters in it, or expelling 
them at some of the natural outlets of the system, as the skin, bowels, 
and kidneys. These appearances occur in the form of boils, eruptions, 
sweatings, diarrhea, mucous and bloody discharges, high-colored urine, 
feverishness, and the like. * * * The true philosophy of these appa- 
rent aggravations of disease is probably this: As the living power, or 
that which we call nature, becomes invigorated, a greater antagonism 
against disease is set up ; the disease then makes a more desperate ef- 
fort to remain, and, in the commotion thus caused, there appears to be 
an increase of the same." 

Doctor J. H. Rausse remarks ( Water-Cure in every Knotun Dif 
ease) : "The conditions of disease during the Water-Cure, and partic 
ularly during the critical periods are, throughout, different from every 
thing which has formerly been witnessed. It cannot be otherwise, 
because this cure stirs up, little by little, all latent and most deeply-hid- 
den matters of disease, and eliminates them through boils, etc. ; on the 
contrary, all former methods of cure suppress the commotion of the 
struggles of disease, and force the causes of disease inward. The es- 



04 THEORY AND PRACTICE. 

sential distinction between water and medicine is, that the former 
drives the peccant matter out of the body ; the latter, however, drives 
it into the body. For this reason the mediciner seldom perceives that 
the causes of diseases are material ; the water-doctor, however, makes 
this sensual perception in every disease. Hence arise the various views 
of the corporality and spirituality of disease." 

Essentially all the authors above quoted mean the same things, how- 
ever fancifully or fantastically their ideas may be clothed in language. 
Remedial efforts are always going on in the organism when it is in any 
way morbidly affected ; and when those efforts are disproportionately 
manifest at one or more points of the body, or through one or more of 
the depurating organs, this manifestation is called a crisis. Critical ef- 
forts attempt to perform a threefold duty : eliminate morbid matters, 
balance the circulation of blood, and equalize the distribution of nerv- 
ous energy. This latter duty is too generally overlooked. Some au- 
thors write as though all the good effected by a crisis, a boil, for exam- 
ple, was the riddance of a specific quantity of morbid material ; but this 
is a very narrow view of the subject : that is indeed one, but the least 
of the remedial effects accomplished. The amount of morbid matter 
deterged from an extraoi'dinary boil in a week would not equal the or- 
dinary daily elimination of morbid matter from the skin or kidneys. 
The greatest effect, therefore, is the restoration of more efficient vital 
action, the better radiation of vital power from the presiding centers of 
organic life. 

All morbid actions are evidences of the remedial efforts of nature to 
overcome morbid conditions or expel morbid materials. All that any 
truly philosophical system of medication can do, or should attempt to 
do, is to place the organism under the best possible circumstances for 
the favorable operation of those efforts. We may thwart, embarrass, 
interrupt, or suppress them, as is usually the case with allopathic prac- 
tice, or we may direct, modify, intensify, and accelerate them, as is 
the legitimate province,of hydropathic practice. But we must confess 
to the paradoxical proposition, that the symptoms of disease are the evi- 
dences of restorative effort ; the effort, however, may be unequal to the 
end in view, and hence the powers of nature are to be assisted by re- 
moving obstacles, diverting irritation, etc. 

To place this subject in a stronger, and perhaps clearer light, let us 
imagine that before our eyes stands an invalid, laboring under a compli- 
cation of common infirmities, having also "suffered many things of 
many physicians," and that by some clairvoyant or other kind of vision, 
we can see through him. What do we discover ? The whole mass 
of blood is thick, dark, <iscid, and loaded with bilious particles; the 



CRISES. G5 

liver is indurated and torpid, and secretes but .ittle bile, and that little 
remains so long in the biliary passages that it becomes partially decom- 
posed, and, to some extent, putrescent and acrid: and where it enters 
the duodenum, it corrodes its mucous surface ; the stomach has been 
so long plied with luxurious living, that its vessels are red, inflamed, and 
its secretion of gastric juice almost entirely suspended ; the colon or 
large bowel is clogged up with hardened fcecal matters, and the rectum 
or lower bowel is full of hemorrhoidal tumors ; the mucous membrane 
of the throat and mouth is covered with an erythematic eruption, and 
the nerves of the tongue and palate are semi-paralytic ; the skin is 
livid, rough, and eruptive, its capillary vessels over-distended with thick 
blood, and its pores clogged up with dead, effete matters; from the de- 
ficient external capillary circulation the internal vessels are overloaded 
and engorged ; the heart labors, throbs, and flutters ; the lungs are 
so oppressed they cannot expand freely, and the system is not suffi- 
ciently decarbonized ; the kidneys are distended, swelled, and their 
secretion imperfect, high-colored, and full of sediment; and last, though 
not least, the brain is constantly pressed upon by the current of ve- 
nous blood which is there dammed up, as it were, by the general ob- 
structions, producing vertigo, headache, and a thousand indescribable 
morbid sensations, etc., etc. 

Such is not an overdrawn picture of a large proportion of Water- 
Cure invalids. Now, what happens under treatment ? The first ef- 
fect of the water processes is to relieve the more prominent, yet more 
external, and less important of the symptoms, as morbid heat, inflam- 
matory action, pain, irritability, symptomatic fever, restlessness, sense 
of general oppression, etc. ; this is usually accomplished within four 
weeks, and the patient feels a newness of life ; his spirits become buoy- 
ant, his step more elastic, and he experiences a sort of general bodily 
exhilaration ; but, like the marred and scarred sapling, which has been 
bent to the ground, and rises up again when the superincumbent 
pressure is removed, he has wounds and bruises to heal. During the 
treatment, changes have been going on in all the machinery of vitality ; 
obstructions have been more or less cleared away ; torpid muscles 
aroused to action ; long-smothered sensibilities stirred up in half-pal- 
sied nerves; the excitability of the contractile tissues re-developed; 
universal commotion has pervaded the domain of organic life. 

In this state of general perturbation, when some parts and organs are 
surcharged with blood, and others blood'ess — some inflamed, and oth- 
ers torpid— some excessively irritable, and others almost paralytic — 
some preternaturally sensitive, and others almost devoid of sensation — 
some oppressed with heat, and others lepressed by cold — with impure 



THEORY AND PRACTICE. 



secretions in many organs, and excrementitious matters choking up the 
capillary vessels more or less in the different structures, it may well be 
supposed that the vis medicatrix naturte would present many phases of 
irregular and disorderly action ; sometimes concentrating the whole 
remedial effort in one direction or to one outlet ; sometimes dividing it 
between several parts, and sometimes making it, with more or less 
force, successively in various directions. 

These efforts are attended with waste or expenditure of organic 
force, and sometimes this expenditure for a time exceeds the replen- 
ishment; hence "reaction," as it is called, fails, and the patient feels a 
temporary depression, in which condition he is very apt to imagine the 
treatment "does not agree with his constitution." Now it is that the 
faith and skill of the patient and physician are put to the severest test. 
If the patient now takes his feelings for his guide, and abandons all 
treatment, Vie may commit a fatal error for himself, and give the whole 
water-system a bad name ; and if the physician perseveres in the use 
of very strong impressions or very cold treatment, this temporary de- 
pression may become permanent, or, at least, unnecessarily painful and 
protracted. All the patient requires is rest, soothing appliances, and en- 
couragement. If he feels very weak, let him follow his feelings in the 
matter of exercise ; walk, sit, or keep his bed precisely as he can best en- 
joy or endure himself. If he is feverish, chilly, or in pain, ad minister- lo- 
cal fomentations, or the warm or hot bath. In brief, he needs an expec- 
tant, nursing management until the organic powers have thoroughly 
rested themselves, and in three, six, or ten days, more or less, full 
treatment may be resumed to advantage. 

But where disease and disorganization have pervaded a large extent 
of the domain of life, these efforts, and these sinkings, these general or 
partial crises, these " ups and downs" may be many before health is 
re-established ; and the physician who undertakes specifically to pro- 
voke a crisis, with the view of curing, as it were, at a single dash, com- 
mits a grave mistake. Crises, or any number of critical efforts or dis- 
turbances, are. always to be desired, but never to be sought by vio- 
lence. 

It often happens that patients whose bodies are extensively diseased, 
yet not very much exhausted in muscular power, experience very great 
benefit at a Water-Cure during the first month, after which they suf- 
fer a slight aggravation of many of their difficulties, and thus remain 
several months apparently in statu quo, not realizing within themselves 
or manifesting externally, any decisive indications of restoration and 
yet in a few months longer find themselves in good health. Such cases 
>f which I have seen many, prove to us that tl e process of repara- 



THE PULSE. 67 



tion, in the domain of the organic economy, like that of growth and de- 
velopment, is slow, silent, gradual, and almost imperceptible, and that, 
although we may rid the system of obstructions, morbid deposits, nud 
active disease by the diligent employment of the Water-Cure pro- 
cesses, the re-establishment of firm and vigorous health requires weeks, 
months, or years, and is influenced favorabty or adversely by every cir- 
cumstance and habit of life. 



CHAPTER IV. 

OF THE PULSE. 

Nature of the Pulse. — All persons who undertake the general 
direction of hydropathic appliances, ought to be familiar with the char- 
acter and indications of the arterial pulsation. There is no surer test 
of the degree of existing vitality, or of the balance of circulation, and 
no better guide for the administration of water-treatment; while its va- 
riations denote, with considerable accuracy, many pathological condi- 
tions of the different organs and systems of the vital domain. For 
these reasons, this chapter may properly form a connecting link be- 
tween the theoretical and practical departments of this work. 

The beating of the arteries, caused by the afflux of blood propelled 
through them by the contractions of the heart, is called the pulse. Its 
characters relate to the force, frequency, strength, a*id equality of the 
pulsations themselves, and of their intervals. The most convenient 
method of ascertaining the state of the pulse is by compressing the ra- 
dial artery at the wrist, with the balls of the first and second fingers ; 
the main force is to be applied by the finger which presses on the ar- 
tery above, or toward the heart. Its strength is determined by the de- 
gree of compression it will bear before it will cease to be felt by the 
finger farthest from the heart. 

Varieties of Pulse. — Medical authors enumerate many kinds of 
pulse, which are both fanciful and ridiculous. All the distinctions which 
are of practical utility are the following : 

The pulse is called regular when its beats are uniform in force, fre- 
quency, fullness, etc., and irregular when it lacks uniformity in theae 
respects. 



THEORY AND PRACTICE. 



A normally strong pulse resists moderate, yet yields readily to se 
vere pressure. 

A preternaiurally strong pulse is almost incompressible. A strong 
pulse is never very frequent, rarely exceeding 80, and never, per- 
haps, 90. 

A hard pulse offers nearly as great resistance at first as a stroDg 
pulse, but yields more easily and completely to strong pressure. 

A soft pulse feels full and round to the finger, but yields steadily and 
readily to pressure. 

A full pulse gives to the finger the sensation of repletion or fullness. 

A contracted pulse is nearly the opposite of the full pulse, the pulsa- 
tions being narrow, deep, and somewhat hard. 

A frequent pulse has an unusual number of strokes in a given time. 
The natural frequency of the pulse at the various stages of life is sub- 
ject to considerable diversity. The average may be stated as follows 
In the embryo, 150 ; at birth, 130; one month, 120; one year, 112 
two years, 105; three years, 100; seven years, 90 ; twelve years, 85 
puberty, 80 ; adult age, 70; old. age, 65. 

A slow pulse makes less than the usual number of strokes in a given 
time. 

A quick pulse is one which strikes sharply and suddenly, as it were, 
against the finger without reference to the number of pulsations ; hence 
it may be quick and frequent, or quick and slow. A quick pulse is 
never very frequent, seldom over 90. 

The pulse is said to be tense when the artery resembles a cord fixed 
at each extremity ; when it feels still harder and smaller, it is called 
wiry. 

A deep pulse is»that which cannot be felt without difficulty nor with- 
out strong pressure. 

A tremulous pulse is one wherein each pulsation oscillates. 

A weak or feeble pulse beats lightly against the finger, ceasing en- 
tirely on very slight compression. 

A small pulse unites the character of the weak or feeble with the 
contracted pulse. 

A sharp pulse is a combination of the quick and frequent ; the artery 
strikes the finger both abruptly and rapidly. 

Tbe pulse is called critical when it becomes free, open, soft, etc. 
after having been irregular or abnormal in these respects. 

The dicrotic or double pulse is that in which the finger is struck 
twice at each contraction of the heart : once lightly aud once more 
forcibly. 

An intermittent pulse is that in which a beat is occasionally missed 



Ill B PULSE. 



as it were ; the intermissions are usually quite irregular, as one in five, 
six. ten, or twenty. 

There are many technical distinctions of pulse, which are either 
unimportant, or merely subdivisions of those already named, as, ardent, 
when the artery seems to raise itself to a point in order to strike the 
finger; goat-leap, an imperfect dilatation of the artery, being suc- 
ceeded by a fuller and stronger one — the artery seems to leap, as it 
were ; convulsive, unequally frequent, or unequally hard; deficient, a 
feeble beat, which seems every instant about to cease ; depressed, a 
pulse both weak and contracted, or deep; filiform, resembling a thread, 
slightly vibrating; flickering, i. e., deficient; hectic, the weak, feeble 
pulse observed in hectic fever; intercussent, one in which a superflu- 
ous pulsation seems to occur occasionally ; intricate, unequally slow 
and imperfectly developed ; jarring, jerking and sharp ; languid, slow 
and feeble ; large, an open and full beat ; long, one which strikes the 
finger to a great extent in length ; low, the pulsations scarcely per- 
ceptible ; resisting, slightly tense or hard ; undulating, the pulsations 
resembling the motion of waves ; unequal, the pulsations being unlike, 
or returning at unequal intervals ; vermicular, resembling the motions 
of a worm ; vibrating, jarring, like the motions of a musical string ; 
oppressed, small, contracted, and slow ; laboring, the blood seeming to 
be but partially emptied at each pulsation, etc. 

Indications of the Pulse. — The preter naturally strong pulse 
is characteristic of high fevers and active inflammations. It is the 
kind of pulse which is said to bear bleeding well ; bleeding does not 
immediately nor sensibly prostrate the patient ; but often relieves pain 
and lessens sensibility. When this pulse exists, no^ matter by what 
name the disease is called, the cold ablution or wet sheet may be freely 
employed and safely continued until the pulse is reduced to the natural 
standard. 

The hard pulse indicates a less degree of inflammatory action, or a 
great degree of irritation, without great debility. It is found in many 
forms of acute and sub-acute inflammation, as gout, rheumatism, pneu- 
monia ; in that form of continued fever called synochus ; in many 
cases of what is called bilious remittent fever, in the early stages of 
intermittent fever, during the hot stage of the paroxysm, and gener- 
ally in the early stages of the exanthems — measles, small-pox, scarla- 
tina, erysipelas, etc. Bleeding renders it softer for a few hours, but, 
unless the cause is removed by some other means, the hardness soon 
returns. Cold applications may be employed under the same restric- 
tions as for the strong pulse. 



70 THEORY AND PRACTICE. 

The soft pulse is always found in the normal state of the circulation, 
and sometimes attends diseases which are not marked by active inflam- 
mation, nor much debility. Bleeding always sinks this to a weak, con- 
tracted pulse. In water-treatment mild applications are most bene- 
ficial. 

The full pulse indicates a good degree of superficial capillary circu- 
lation. Bleeding always permanently depresses this kind of pulse ; 
but cold applications are generally very well borne. It is generally 
found in apoplexy, the hot stage of fevers, the incipient stage of 
pulmonary consumption, etc. 

The contracted pulse indicates capillary obstruction and intense en- 
gorgement. Epidemic cholera affords an extreme example of this 
kind of pulse. It often " rises" on bleeding, to sink more deeply soon 
after. 

The frequent pulse indicates irritation or inflammation, and when 
very frequent great debility. Irritable temperaments manifest a more 
frequent pulse than the phlegmatic ; and females have a more rapid 
pulsation than males. A frequent pulse may be strong up to about 90 
per minute ; but beyond that point debility is generally proportioned to 
the frequency. In complicated affections of the thoracic and abdom- 
inal viscera, the frequency of the pulse is an important indication of 
the locality of the principal morbid condition. Thus, in dyspeptic con- 
sumption — an affection which commences with a diseased liver and 
stomach, and ends with tubercles or ulcers in the lungs — the pulse 
will be moderately slow while the abdomen is the principal seat of 
disease ; it will gradually increase in frequency, as the disease extends 
itself to and occupies the lungs; and be very frequent when the vis- 
cera of the chest, have become the point most dangerously affected. 
Nothing is more common than for experienced physicians to make the 
most egregious mistakes in diagnosticating between diseases of the 
liver and lungs, or between dyspepsia and consumption ; but the fre- 
quency of the pulse, aided by other symptoms, ought always to insure 
a correct diagnosis. The importance of this symptom is enhanced by 
the fact, that in most chronic diseases of the abdominal organs, the 
pulse is preternatural])' slow ; while in all idiopathic affections of the 
chest it is more or less preternaturally frequent. In those dyspeptic 
affections or disorders of the liver, attended with a dry, husky cough, 
a tenacious secretion of the throat, or a glutinous mucous expectora- 
tion from the lungs, there is always danger of confirmed consump- 
tion when the pulse begins to beat with considerable frequency, say 
from 80 to 100. 

The slow j>ulse iudicates torpor, inaction, especially in the functiouj 



THE TlTLSIv 71 

auxiliary to digestion. Compression of the brain, from contusion, or ef- 
fusion, or engorgement, not unfrequently produces a very slow pulse. 
Dyspeptics and hypochondriacs often manifest an extremely slow pulse. 
In all of the above cases the pulse frequently sinks to 50, and oc- 
sionally to 40. A change in dietetic habits, if it be from highly-season- 
ed, stimulating, or animal foods, to plain, simple, vegetable dishes, is 
always accompanied with a reduction in the frequency of the pulse. 
The long and slender arteries of tall and slim individuals beat less 
frequently than the shorter, thicker vessels of an opposite organization. 
The quick pulse is similar in its indications to the hard pulse ; but 
usually denotes a greater degree of irritation or inflammation. 

The tense pulse denotes excessive irritation with considerable de- 
bility. It is usually found in constitutions which possess great activity 
with little strength. 

The deep pulse is merely owing to the situation of the artery, 
which runs deeper beneath the integument than usual. 

The tremulous pulse indicates extreme nervous debility with violent 
irritation, or excessive internal congestion. Tea, snuff, alcoholic bev- 
erages, and cigars are among its common causes. 
The weak or feeble pulse indicates debility merely. 
The small pulse denotes debility with more or less local irritation. 
The sharp pulse indicates more or less debility with great irritation. 
The critical pulse denotes the subsidence of irritation; a more 
perfect equilibrium in the circulation, and a general improvement in the 
patient's condition. 

The double pulse usually attends organic affections of the heart or 
large arteries; yet it is sometimes found in very nervous dyspeptics, 
especially those who have indulged freely in nervines and narcotics, as 
?offee and tobacco. 

The intermittent pulse is extremely common with dyspeptics, nerv- 
ous invalids, sedentary persons, and those who are subject to constipa- 
tion, and also with old persons. It not unfrequently occasions great 
alarm, being erroneously supposed to indicate aneurism, heart disease, 
or some other formidable and fatal malady. It indicates thick, viscid 
blood, capillary obstruction, or nervous exhaustion. Overloading a 
weak stomach, almost always produces an intermittent pulse for a time, 
as do night suppers, and going to bed soon after eating. 

The sub-varieties of pulse indicate complications of the conditions 
which five rise to the more distinct varieties, and are attributable to 
constitutional peculiarities, personal habits, local irritations, and many 
other circumstances relative to the individual, the disease, and the treat- 
ment. 



72 



PART V.. 

PATHOLOGY AND THERAPEUTICS. 



CHAPTER I. 

OF FEVERS. 

Classification of Fevers. — The nosological arrangements of fe- 
vers, as found in medical books, are all, in my judgment, unphilosoph- 
ical and absurd. Without wasting any of my limited space in exposing 
their errors, I will at once propose a classification which shall, at least, 
make a nearer approximation to pathological propriety. 



Nosological Arrangement of the Simple Fevers. 

' 1. Ephemeral. — One day Fever, 
2. Inflammatory. — Synochus — General Inflammation, 
Yellow Fever, ( Ship Fever, 
Nervous Fever, 
Putrid Fever. 



3. Typhoid. 



4. Remittent. 



5. Intermittent. 



Marsh Fever. 



] Spotted Fever, 
<{ Camp Fever, 
| Jail Fever, 
( Hospital Fever 

Nervous Remittent, 

Putrid Remittent. 

Quotidian — Everyday Ague, 

Tertian — Third day Ague, 
( Quartan — Fourth day Ague. 

f Hectic Fever, 
Puerperal Fever, 
Mesenteric Fever, 
Milk Fever. 
' Small-pox, 
Chicken-pox, 
Cow-pox, 
Measles, 
Scarlatina, 
Erysipelas. 
Miliaria, 
k Plague 



7. Eruptive. 



FEVERS. 



-3 



From this arrangement I have excluded the "bilious fever" and the 
"synochus," or "mixed fever" of authors. A mild form of the putrid 
typhus, when accompanied with bile in the stomach, and a yellowish 
conjunctiva, is often called bilious fever ; so, also, is either form of re- 
mittent. The "synochus" is said by some authors to be bilious in the 
beginning, and typhus in the end. This is simply absurd. Other au- 
thors denominate it inflammatory at the outset, tending to a typhoid 
termination. This is mistaking an aggravation of symptoms for a 
change of type. Bystanders are often astounded at the bedside of the 
patient by hearing the physician announce that the fever has changed 
type, from bilious or inflammatory, to typhus or typhoid. All this 1 
regard as sheer nonsense. All that it can mean in plain English is, 
the patient is worse, or has approached the critical period or turn of 
the fever. 

The "congestive fever," as it is generally called in ojjr Southern and 
Western states, is merely a severe form of intermittent or remittent, 
attended with the symptoms of a disproportionate engorgement of the 
bruin or lungs. Sometimes a malignant form of typhus is called con- 
gestive fever, and occasionally almost all forms of fever, accompanied 
with severe congestion of some important viscus, are designated by 
this unmeaning term. European authors have entitled similar cases 
" pernicious fevers." by way of distinction ; a more uncouth and sense- 
less appellation than congestive- 
Doctor William Jenner, professor of pathology in University College 
(Braithivait^s Retrospect, Part XXIII.), has lately classified continued 
fevers into typhoid, typhus, relapsing anAfabricula. This "relapsing 
fever," we are told, is known by a reproduction of most of the febrile 
symptoms in about a week after the patient has become convalescent. 
He is then, without any apparent exciting cause, without any error or 
indiscretion on his part, reattacked with violent fever, which lasts sev- 
eral days, and then terminates in profuse perspiration. A more ap- 
propriate name for this febrile disturbance is drag-fever. It is per- 
fectly clear to my mind that, after the patient's body has been satu- 
rated, as it were, with drugs, as in the ordinary treatment of a fe- 
ver, the vital powers will endeavor to get rid of the drug-medicines as 
soon as they haye recovered sufficient energy to make the effort ; and 
this effort is what Dr. Jenner distinguishes as a distinct species of fe- 
ver, which he calls " relapsing," and treats with another course of 
drugging. 

' This explanation is confirmed, if not demonstrated, by the fact that 
the patients whose fevers are treated hydropathicaliy, never haye a re- 
lapsing repetition of the fever, nor any thing like it. - 



74 PATHOLOGY AND THERAPEUTICS. 

Guneral Character or Fever. — A fever is a simultaneous ab- 
normal disturbance of most or nil of the bodily functions, such disturb- 
ance being manifested in periodical paroxysms, more or less severe and 
prominent, of cold, hot, and sweating stages. 

It commences with languor, lassitude, and general disquiet, followed 
by shivering, rigors, or chills, then succeeded by hot flashes over the 
surface, with aching sensations in various parts of the body, particular- 
ly about the, small of the back. Finally a preternatural heat, redness, 
and turgescence pervades the whole body, accompanied with head- 
ache, furred tongue, frequent pulse, deficient secretions, and prostra- 
tion of strength. Sooner or later the superficial heat and redness par- 
tially or totally subside, and the paroxysm is terminated with more or 
less general or local sweating. Either stage of the paroxysm may be 
disproportionately severe, and eithei ">ny be so slight as to escape 
notice. 

Causes of Fevkr. — It. would be a profitless waste of words to enu- 
merate specifically all the circumstances which are supposed to be 
among the predisposing and exc'tmg causes of fever. In a general 
sense they may be sum ned up very briefly : local cuntag ous or poi- 
sons, unliealthful food, impure water, v, tinted air, personal uncleanli- 
ness, over-ex.err.on, atmospheric v.cissitudes, gluttony, intemperance, 
etc. 

Medical books are full of amusing specimens ot thoughtless state- 
ments on this prolific subject. Thus Hooper, in his •' Physician's 
Vade-Mecum, with Improvements by Guy and Stewart," gives us the 
Dredisp.ismg causes of inflammatory fever in the following words: 
'Plethoric hab.t of body, with a strong muscular system; a good and 
un'urqi --iired constitution!" If muscular strength and a good constitu- 
tion predispose us to disease, it is certainly very dangerous to have 
good health! The same author gives U3, as among the predisposing 
causes of yellow fever, "the male sex," and among those of miliary fe- 
ver, "the female sex !" It is of such stuff that many medical booka 
are made. I only marvel that some transcendent genius has not re- 
corded human nature as a predisposing cause of disease! 

Theory of Fever.— Since medicine became n system — it never 
was a science- — theories of fever have, nore than any other subject, 
displayed the genius of the great masters of the profession. The very 
names of all the dilfereut ones that have been written, would fill a vol- 
ume ; yet, at this day, we have in our medical schools no generally- 
recognized theoiy All is now as vague, indefinite, and unsatisfactory 



FEVERS. 75 

as in "the dark ages;" and the existing opinions of living authors re- 
garding the nature of fever, are speculations of the most chimerical 
character. 

Still, the whole subject seems simple enough. The reason why an 
explanation has never been found is, I apprehend, because it has never 
been sought in the right direction. A man who shoulJ look to the 
moon all his lifetime in search of the " philosopher's stone," might not 
discover it though lying at his feet. Medical philosophers, instead of 
rationally tracing the effects of riotous living and abused hygienic agen- 
cies, have expended oceans of midnight oil and centuries of brain la- 
bor in tiying to think oat some specific, strange, hidden, occult, myste- 
rious, extra-natural thing, substance, element, or cause, whose exist- 
ence should, in some magical planner, account for all the phenomena 
of fever. Of course, all their toil has been in vain. It has been rathei 
worse than labor lost, for the writings and teachings of medical books 
and medical schools are so tinctured and mystified with the vagaries of 
medical professors, that the student of tvdicine is morally certain to 
get his mind more or less befogged, and his judgment to some exteni 
warped by their influence. 

Type or Fkvf.r. — A man of strong, vigorous constitution, accustomed 
to an active out-door life, yet regardless of healthful habits, eating and 
drinking what comes in his way, as is the fashion of the world, is ex- 
posed to unusual cold, wet, heat, labor, or some similar vicissitude. In 
a day or two he has a fever. Its type will be inflammatory, because 
his vital energies are strong and his viscera powerful, and in him na- 
ture — the organic instinct of self-preservation — is successful in throw- 
ing the morbid action to the surface. If the disturbing causes are 
slight, it will be ephemeral in duration; if more severe, typhoid. 

Another man, of feeble constitution and sedentary life, is similarly 
exposed and similarly attacked. His fever will be typhus. There is 
less ability to react successfully, and the kuernal commotion is pro- 
portionally greater. The surface is less turgid, but the viscera suffer 
more internally. The brain manifests delirium, the lungs engorge 
ment, the liver congestion, the stomach and bowels torpor or relaxa 
tion, and some physicians will call it congestive fever. 

If either of the above patients has been gross in his eating habits ; 
if pork, ham, sausages, cheese, and fine, constipating, farinaceous food 
have constituted a large proportion of his diet, he will have a yellow 
tongue, bitter taste in the mourfi, bile in the stomach, etc. Then his 
fever may be called bilious. 
... The man of impaired constitution anc' wea*. digestive powers, who 



76 PATHOLOGY AND THERAPEUTICS. 

is attacked with typhoid fever, will have the nervous form, if his brain 
and nervous system have been particularly abused, overworked, or 
stimulated by tea, coffee, liquor, or tobacco, and the putrid form if his 
personal and dietetic habits are gross, and particularly constipating and 
obstructing. 

The. yellow variety is produced by causes which especially operate 
to impair the secretion of the liver, as excessive heat, animal or vege- 
table miasms, combined with gross diet and stimulating drinks. Every 
kind of animal food, except, perhaps, milk, in very warm climates, I 
regard as a predisposing cause of yellow fever. 

The other forms of typhus, called ship, spotted, jail, camp, and hos- 
pital fevers, are nothing more nor less than the common or typhoid 
fever, modified by local causes and particular personal habits. 

Remittent fever may be of the nervous or putrid tendency, for the 
reasons already assigned. Its remittent character is owing undoubt- 
edly to a disproportionate affection of the liver and spleen, a condition 
of obstruction and engorgement produced by noxious effluvia, or any 
impurities from decaying vegetable and animal matter, to which the 
system has been for a long time exposed. 

Intermittent fever is the result of the same causes operating more 
gradually, that is, in less force, and for a longer time. The periodicity 
of the paroxysms must be referred in part to organic laws and in part 
to constitutional peculiarit'es. This view of remittent and intermittent 
fevers is confirmed by the fact that enlargements and indications of the 
large glandular structures, the liver, spleen, and pancreas, are most 
frequent in those who have been the subjects of protracted agues. 

Symptomatic fevers are merely states of constitutional irritation 
from local causes, generally chronic topical inflammation. Thus hectic 
fever is a general febrile disturbance from tubercles or ulceration of 
the lungs. Puerperal fever is a consequence of inflammation of some 
one or more of the abdominal or pelvic viscera or appendages, gen- 
erally peritoneal inflammation after childbirth. Mesenteric fever 
arises from worms, indigestible food, etc. Milk fever is occasioned 
by an inflammatory state of the female breast. 

Eruptive fevers are characterized by an accompanying rash, efflor- 
esence, eruption, or pustular affection of the skin. They are gener- 
ally contagious, and depend on a specific virus, which works through 
the blood like a ferment. The precise modus operandi by which this 
infectious element is first produced caunot be precisely explained; yet 
the principle or law of its generation and operation is sufficiently ob- 
vious. Vegetable ferment, called yeast, it is known is produced from 
decomposition of vegetable matter. This is in reality a rotting process. 



7EVEBS. 77 

by which certain proximate principles are decomposed and so roar- 
ranged as to constitute an entirely new product. The new product, 
of course, holds an unphysiological scale of cheirrrsal affinities in rela- 
tion to the constituents of tht healthy fluids, and hence when brought 
into contact with those fluids, another set of chemical actions, decom- 
positions, and recombinations takes place, by which some element is 
changed, modified, or destroyed. 

We know, too, that when animal secretions or excretions are in a 
certain decomposing state, which is exactly analogous to vegetable fer- 
mentation, they will, by being brought into contact with the blood of a 
healthy person, produce more or less of a similar change or decom- 
position in its elements. Poisoning from dissection is a familiar illus- 
tration. Personal filthiness, combined with foul and unclean food, 
will develop an infectious matter and disease the structures, and by 
contact, communicate a similar morbid action to another in compara- 
tive health, as the horrible story of prostitution in cities can tell. We 
can then easily understand the law which develops infection of all 
kinds, if we cannot detect its chemical nature ; and for all practical 
purposes, a knowledge of the law is sufficient. 

All large collections of rotting or decaying vegetable and animal sub- 
stances engender the poisonous ferment of contagious and other 
fevers ; and if we look over the whole surface of the globe, we can 
easily find sources enough to account for all the infection, whose re- 
sults are manifested in putrid, malignant, and contagious fevers, dys- 
entery, cholera, etc. Thousands of human bodies, and the carcasses 
of beasts, lie rotting on the battle-fields of this blood-stained earth, from 
which currents of deadly virus are borne by the winds to infect the 
breath and blood of people at a distance of hundreds and thousands of 
miles ; the graveyards and cesspools of all large cities are constantly 
sending forth streams of death in all directions ; and hardly a country 
place can be found where there are not local sources of this deadly 
ferment in the shape of hog-pens, distilleries, slaughter-houses, etc. 
And when the infectious ferment is once produced, it has the power 
of propagating itself whenever it can find congenial elements in the 
fi'aids of our bodies, our only defense being vigorous functions and 
pure blood — good health. 

Rationale of Fever. — The living organism is endowed with the 
inherent power of self-preservation. Each organ or part, to a certain 
extent, resists all morbific influences, and expels all morbific materials 
from the body through the various excretories. If the causes of dis- 
ease — all of which may be sun.med up under the heads of impure or 



78 PATHOLOGY AND THERAPEUTICS. 

obstructing materials, and exhausted nervous power — diminish the dep- 
urating power of the skin, the liver, bowels, kidneys, and lungs, in- 
crease their labors to keep the body pure. If the liver becomes clog- 
ged up, the lungs, skin, bowels, and kidneys undertake the office of 
the impaired organ. If the kidneys are impaired functionally, the 
skin, lungs, etc., have an augmented duty. But the causes of disease 
often operate and increase sl gradually that all the excretory functions 
are impaired. Hence the effort to relieve the system must be gen- 
eral—universal commotion takes place. Some organs were originally 
stronger than others ; some have been more injured than others by 
bad habits or previous diseases ; hence the struggle will not be equally 
balanced. Though all the vital energies co-operate in the " effort of 
nature," they will act with irregular and unequal energy. The whole 
vital machinery is thrown into disorder. There is a fever. The. kind 
of fever depends on the circumstances already adverted to. 

But alternate action and repose is a general, universal law of the 
animal economy. After the organism has prepared itself for the rem- 
edial and expulsive effort (the cold stage), the vital instincts (vis medi- 
cairir nature) direct their whole energies to the surface (the reactive 
or hot stage), as the best channel of purification. At length fatigue 
ensues, and repose must and will be had. The heat abates, the heart's 
action becomes milder, the turgescence subsides, and the collapse, or 
sweating stage, concludes the paroxysm. 

If the morbific causes were slight in intensity, and the morbid ma- 
terial small in quantity, the single struggle may have sufficed to set the 
vital "house in order." Then the paroxysm will not be renewed. 
Otherwise it will be repeated again and again, until "victory or death" 
results. 

If this view of fever is right, the drug-system of treatment must be 
wrong. Instead of "aiding and assisting nature," it tends to smother 
her efforts, and adds still other extraneous agents for the vital powers 
to contend against. 

But it may be asked, by way of objection to the treatment I shall 
advocate : AVhy, then, if the paroxysm of fever is a remedial effort, 
do you disturb this effort with your cold, or tepid, or hot-water pro- 
cesses ? Why cool the hot stage of a fever with cold bathing, and 
'object to cooling it by cold bleeding and cold drugging? I answer : 
The organic instincts are true to nature ; they are infallible in the 
matter of mere existence. But they are not intelligent; they are 
not reasoning entities. Tt the stomach is attacked with a poison, say 
a " blue pill" or a glass of grog, it will be true to itself, aud yet be sat- 
isfied to pass the offending agents off to the liver or the skin. If the 



FEVERS. 79 

bowels are attacked with a portion of epsom salts, or a dose of " No. 
6," they will either puss it off rapidly, or, failing in that, pour out se- 
rum to defend themselves. If the circulating fluids are charged with 
animal oils, the capillary vessels will deposit it in the cellular tissues. 
All these partici lar functions act also for the general good ; but while 
each and every function participates in a general way in the preserva- 
tion of the whole domain of life, each organ has its own special law 
of self-preservation. Hence when all the organs are struggling to re- 
lieve themselves, disorder, and riot, and excess may result. And here 
right reason may come to the aid of instinct by supplying favorable 
conditions, as perverted judgment has brought the trouble about by 
forcing unnatural conditions upon the organism. By all those means 
which help those efforts of nature to maintain or obtain the circum- 
stances which constitute the normal state, without calling out a further 
expenditure of vital power, nor adding still other morbific agents, nor 
chemically Injuring the structures, we may truly practice "the heal- 
ing art." 

Crisis of Fkvkr. — Since the days of Hippocrates, the opinion has 
prevailed that fevers naturally, if left to themselves, evince a tendency 
to run a certain course, and terminate in a given time by a sudden ag- 
gravation of the symptoms, called sinking, or a complete subsidence of 
them, and the commencement of convalescence. This change has 
been called the crisis, and the days on which it occurs, critical ilatjs. 
The 3, 5, 7, 9, 11, 14, 17, and 20, have been regarded as critical days. 
Because of this tendency, many drug-aulhors are oppose! to all at- 
tempts to break up the disease or shorten its course. Their plan is to 
conduct it through its course; but how do they propose to conduct it 
through its course ? Why, by poisouing the body through and through, 
with course after course of drugs! There is nothing known to civili- 
zation more thoroughly barbarian than the drug treatment of a fever. 

The subject, of crise3 in acute diseases is of no practical consequence 
whatever. Under water treatment, the only crisis observable is the 
cure. Crises proper, under hydropathic management, are known only 
in chronic diseases, and in these neither crises nor cures are scarcely 
known in allopathic practice. 

Duratiox of Fkver. — The ordinary duration of inflammatory fe- 
ver is from one to two weeks; the nervous form of typhus, from tour 
to six, or even eight weeks ; the putrid form from two lo three weeks; 
remittent fever from two to four weeks, when treated according to the 
popular system. Intermitting fever is often "broken" in a few days, 



80 PATHOLOGY AND THERAPEUTICS 



but seldom cured, and generally reoccurs at uncertain intervals for 
moDths or years. Ephemeral fever is frequently converted, by one 
unfortunate dose, or a severe bleeding, into a protracted fever which 
runs several days or weeks. Under water-treatment it is very rare for 
any fevers, except the eruptive, to hold out over a week ; and in erup- 
tive diseases, whose febrile excitement usually continues from seven to 
eleven days, the violence of the disease is generally entirely subdued 
within one week. I have never yet personally known a fever run 
over a week under water-treatment, and I have treated all the common 
forms in New York city for the last seven or eight years— ephem- 
eral, inflammatory, typhus, ship, scarlet, measles, small-pox, etc. 

General Treatment of Fever —The indications are : 1. To 
equalize the circulation. 2. To purify the body. Practically these 
distinctions may be more nice than wise ; for all the means best calcu- 
lated to fulfill one indication are also the best adapted to the other. 

Bathing. — Nothing in the way of medication is more beautifully sim- 
ple and promptly successful than the hydropathic management of a fe- 
ver. The temperature of the body is the sure and invariable guide for 
the water processes. If the whole surface of the body is hot, cold wa- 
ter is to be applied by frequent ablutions, or the rubbing wet sheet, or 
the wet-sheet pack, and often repeated until the temperature is re- 
duced to the natural standard. The pack is the most pleasant and 
most effectal process, and its soothing and tranquilizing effects upon 
the whole nervous system far exceed all the opiates in the world. If 
the temperature rises again, the processes are to be repeated in the 
same manner. If the feet are cold, they should be held in hot water 
a few minutes, or a bottle of hot water may be applied to them. Es- 
pecial attention must be given to warming the feet in all cases where 
the head is oppressed and the lower extremities are inclined to be cold. 
In what are called low or nervous fevers, there is often great heat and 
irritation of the head, and great torpor, coldness, or numbness of the 
lower limbs. In these cases it is indispensable to balance the circula- 
tion by cold applications to the head and hot to the feet before resort- 
ing to the wet sheet. In very low fevers, and in all cases attended 
with extreme prostration and unequal temperature at ihe outset, fre- 
quently sponging the body with tepid water, is better than the wet- 
sheet pack, or very cold ablutions, for the reason that the shoe!, of the 
latter tends still more to disturb the equilibrium of the circulation. 
Local pains, spasms, etc., are to bo relieved by cold applications or ■warm 
fomentations, as either feels most grateful. As a general rule, cold 
compresses are most beneficial when there is constant heat, tender- 



FEVERS. 81 

ness, and distention ; and warm applications are indicated when the 
distress is periodic or spasmodic, or when unattended with heat, tur- 
gescence, or soreness. Severe headache may be generally relieved by 
cold wet cloths, and always readily subdued by pouring cold water over 
the temples and back part of the head for several minutes. This pro- 
cess will also generally relieve the severest retching, nausea, and 
vomiting. 

I have never tried the process of immersion in treating fevers, but 
have every confidence that it would prove eminently efficacious in all 
high fevers — fevers attended with uniform and general heat of the sur- 
face, and a str<;a a , hard pulse. 

There is now living in a secluded town in Missouri an old farmer, 
who has practiced Water- Cure even longer than Priessnitz. A com- 
munication from him, addressed to the publishers of the Water-Cure 
Journal, will occupy two or three pages with as valuable matter as 1 
could select from any source whatever ; and, notwithstanding the au- 
thor modestly desires to have some other name take the credit of giv- 
ing his experience to the world, 1 shall take the liberty to record his 
name, and present his letter in his own farmer-like and unaffected sim- 
plicity of style and language: 

" East Prairie, Mississippi Co., Mo., JVov. 30, 1850. 
" Messrs. Fowlers and Wells : 

"I am a farmer, in my seventy-fifth year. I have taken your Jour 
nal since January last, and have taken Wilson & Co.'s little Dispatch 
for two or three years, and have always sent to him for any books he 
advertised on the subject of the Water-Cure, with the request that he 
would send me the best and plainest he could procure. I think I have 
seven or eight of them, but in -lone of your Journals, nor in them, do I 
see where fevers have been treated with the success that I have treat 
ed them with for more than thirty years, and I have never failed in & 
single case to make a perfect cure in a few minutes. Strange as this 
may seem, it is nevertheless a fact, and this is the reason why I trouble 
you with these lines. I have no nterest in deceiving you or any other 
person ; and as for having my name published in your Journal as a 
great Water-Cure doctor, I wish you not to publish this, but give it to 
some person of your acquaintance in whom you have confidence, who 
will give it a fair trial, or to several, and if'it succeeds, as I know it will, 
publish the fact in any person's name you please except mine. 

" I have treated all fevers, fever and ague, etc., alike. My plan is 
simply to bathe at the time the fever is the highest; if the. fever has 
passed its highest point, and is g>ing off, I let the patient alone until it 



82 PATHOLOGY AND THERAPEUTICS. 



returns. I know nothing of wet sheets, bandages, etc. ; but when the 
fever returns, or gets as high as I think it will go, I put the patient in 
a hogshead that I keep for bathing. I have him go entirely under wa- 
ter, head and all, for three or four tim°s, keeping his head under each 
time as long as he can conveniently hold his breath ; then let him dab- 
ble in it up to the chin until the heat is reduced to the natural temper- 
ature, and the patient feels comfortable ; then let him come out and 
wipe dry with towels, put his clothes on, walk about, lie down, or do as 
his inclination leads ; eat what he will, drink what he pleases ; as for 
rubbing, I do nothing of the kind. I pay no attention to the temper- 
ature of the water, the object being to bring the patient to the natural 
heat, and this can be done in fifteen or twenty minutes. 

"When I have no convenience for bathing, and, in fact, sometimes, 
as a matter of preference, I pour water on the patient's head, instead 
of bathing; and, surprising as it may seem, this always has the same 
effect that bathing has, and I do not know that it takes longer to cool 
the body in this way than it does by bathing. 1 have the patient 
lie with the head over the edge or side of the bed, so that the water 
will not wet the bedding. I then get a bucket of the coldest water, 
place it under the head, and pour the water over the back of the head 
from one temple to the other, the patient lying with the face down- 
ward. I pour it on moderately, and at the height of the fever ; I think 
it will have little effect if done at any other time. Pouring water on 
the head in this way will cool the whole body nearly or quite as soon 
as going all under water, as before directed. If the water is not poured 
on long enough at, first, the fever will return in a few minutes, but re- 
peat the pouring then as at first. I have known the fever return twice 
before it was finally driven away. 

"The next day after the treatment the patient is capable of attend- 
ing to business as usual, and I do not recollect a case in which the pa- 
tient had another attack the same season. There is one thing I can- 
not understand — how pouring water on the head should relieve the 
stomach of bile ; but so it is ; let the r«tient be ever so sick at the 
stomach, and incline to vomit ever so much, in two minutes after you 
begin to pour water on the head, the stomach is relieved, and there is 
no more of that trouble. As before stated, the cure is completed in a 
few minutes, and it is a permanent cure, and a cir e that all persons 
can perform at home without an}' inconvenience. The shortest time I 
have seen noted in any of your books to cure tl e fever and ague is five 
days, and that with your wet sheet, etc. ; I am sure this plan is a great 
deal easier, and much quicker ; and again, these books give no direc- 
tions wheo to commence the treatment, which I am certain is a mate- 



FEVERS. 83 

rial point. I am sure if my mode is not employed as directed, at the 
height of the fever, it will fail. As stated in the beginning, I am no 
doctor, neither did I make this discovery myself. I lived forty-two 
years on the Sciota bottom-land *, in Sciota county, Ohio, the most no- 
ted place for bilious complaints primps in the world. A physician who 
had attended my family, being about to move away, I asked him whom 
1 should apply to after he was gone, in case of sickness. He then told 
me how to apply water in all cases of fever. I have now tried it more 
than thirty years, and have never failed. 

"The effect the cold bath had on me last spring, in the worst dysen- 
tery I ever experienced, which I learned from Dr. Shew's Water- 
Cure for the cholera, no person would believe. I could name a great 
many cases of different kinds of bowel complaints, which have been 
successfully treated with Water-Cure ; but it is a very smart under- 
taking for me to write a few lines, my hand is so unsteady, and I fear 
it will be a greater task still for you to read them. But I thought it 
was a duty I owed the community to make known my experience in 
the treatment of fevers with water, especially as there is considerable 
stir at this lime about the Water-Cure. But I have found that almost 
ninety-nine in a hundred have been opposed to the application of cold 
water in any case whatever. The few who have tried the cure as di- 
rected, have never failed to get well speedily ; yet, even they would 
almost always, on the next attack, apply to a drug-doctor. In the cases 
of small children, I have induced their mothers to hold them in a buck- 
et or tub of water, and wet their heads continually for five minutes. I 
have never known this fail to cure the chills and fever ; let it be dona 
also when the fever is at the highest. 

" I am respectfully yours, etc., 

"Abraham Millar." 

Since I have been in possession of the old farmer's experience, 
I have employed the pouring head bath more freely than ever be- 
fore, and never without decided benefit. I deem it a valuable aux- 
iliary to the wet sheet in all high fevers ; in low fevers it cannot be as 
promptly successful, yet may be very serviceable ; but care must be 
taken to keep the lower extremities warm, lest its application should 
produce reaction toward the brain. It will not, of course, cure pro- 
tracted agues which are complicated with enlargement of the liver or 
spleen, but may in those cases very much shorten the duration of the 
disease if employed according to Mr. Millar's directions. 

There is another very simple and very efficacious method of treating 
Kii ordinary fever, whicl} has the advantage of always being convenient. 



84 PATHOLOGY AND THERAPEUTICS. 

and may, for this reason, be preferred by those who do not well un- 
derstand the management; of the wet sheet, or who have not conve- 
niences for the immersion or plunge-bath. Place the patient in a hip- 
bath — a common wash-tub — and two pails of water will answer; let 
the water be of a moderate temperature, 65° to 75°, and wash him all 
over the back and chest while in the tub ; apply, also, several folds of 
linen to the head, wet in cold water, and changed very often until the 
head becomes cool, and if there is the least tendency to coldness of 
the feet — as there will be if there is great determination to the head — 
put them in a pail of warm water. The patient may remain in the 
bath five, ten, or fifteen minutes, if his strength permits. This process 
maybe repeated as often as there is an exaggeration of the hot stage of 
the febrile paroxysm. When the patient is too weak to sit in the tub, 
the head and feet may be treated as just recommended, and the whole 
surface of the body frequently sponged with tepid water while the hot 
stage continues. 

There are some cases of" low nervous fevers wherein the heat is 
very unequally developed — the pulse very small and weak, the head 
oppressed or giddy, with great tendency to faint on slight exertion. In 
these cases reaction is so feeble that the full pack, so far from soothing 
the patient, increases the internal congestions, rigors, and local pains. 
Here the proper plan of treatment is to soak the feet occasionally in 
warm water, applying very cold compresses to the head at the same 
time ; apply cold wet towels to the stomach, bowels, and back when- 
ever there is continuous heat and tenderness about those parts, and 
sponge the whole surface of the body over with tepid water frequently 
whenever there is general and uniform heat and dayness. Continue 
this plan until the fever is gradually and finally abated. 

Water -drinking. — Water should always be taken freely when there 
is thirst ; and when the heat and dryness of the surface is great, and 
the tongue parched, it should be taken as copiously as the stomach will 
bear without unpleasant distention, even though there be no distinct 
sensation of thirst. In this case it should be taken frequently, but in 
small quantities at a time. 

The Excretions. — When the bowels are not entirely free, they should 
be moved by one or more tepid injections. This may be done either be- 
fore or after the cooling processes have been employed. Subsequent- 
ly injections are only required whenever a sense of fullness, hardness, 
distention, etc., of the abdomen indicate an accumulation of foecal mat- 
ters, whether this condition occurs daily, or only once in two or three 
days. Indian or wheat-meal gruel promotes the action of the bowels, 
and for this purpose they may be taken to advantage when the eonsti- 



FEVERS. 85 

•ntion is considerable. Emetics are rarely necessary ; I never pre- 
scribe them, except there is evidence of crude ingesta recently taken 
into the stomach. In this case the patient should drink warm water 
until vomiting occurs, or relief is obtained without. Copious warm wa- 
ter-drinking will often relieve nausea and distress from offensive acids, 
acrid bile, or irritating secretions in the stomach and duodenum, even 
though it does not produce sickness or vomiting. 

Regimen. — Of the importance of free ventilation, perfect cleanli- 
ness about the room, frequent changing of the bedding, and the prompt 
removal of all offensive dejections or excretions, I hardly need speak. 
Common sense ought to be a sufficient guide in this respect. But there 
is general error committed by physicians and nurses, in the manage- 
ment of a fever, to which I wish to call especial attention. While all 
admit the free access of air, many are inclined to shut out the light. This 
error is more prevalent, accordiug to my observation, in the country than 
in the city. The patient is often kept in a room so darkly shaded.that there 
is an uncomfortable feeling of dampness or chilliness within, especially 
when the room is opposite the sun side of the house, or the house 
thickly surrounded with trees and shrubbery. The influence of light 
is not only vivifying to the patient, but it tends, also, to decompose and 
dissipate putrescent or infectious particles which gather in the sick 
room. There may be cases where the eyes are so excessively irri- 
table and tender to light that it is necessary to shade them, but this 
should be done by a green vail or other eye-shade, while a good de- 
gree of light is admitted into the room. These remarks apply, of 
course, to natural or daylight, not artificial or lamp-light. 

In relation to food and drink, the rule of practice is not difficult to 
memorize. The patient should drink at all times to the full satisfac- 
tion of the sensation of thirst; although, as just observed, when thirst 
is violent it should be taken frequently in small quantities. Crust-wa- 
ter, corn-coffee, lemonade, apple tea, etc., are no better than pure 
water in any case ; but as patients often have a craving for them, and 
as they are both grateful and harmless, I would never object to them. 
Food should not be taken at all until the violence of the fever is mate- 
rially abated, and then very small quantities of the simplest food only 
should be permitted, as gruel, with a little toasted bread or cracker, 
boiled rice, mealy potatoes, baked apples, etc. There is not a more 
mischievous or more irrational error abroad in relation to the treat- 
ment of fever than the almost universal practice of stuffing the patient 
continually with stimulating animal slops, under the name of "mild, 
nourishing diet," beef tea, mutton I roth, chick m soup, panada, etc. 
The fever will always starve out before the patient is injured bv absti- 



86 PATHOLOG'Y AND THER ATEUTiCS. 

nence, at least under hydropathic treatment, and the appetite will al- 
ways return when the system is capable of assimilating food. 

Local Complications. — Among the common incidents attending 
the progress of a fever treated in the ordinary drug way, are, ex- 
cessive irritability of the stomach, vomiting, diarrhea, hemorrhage from 
the liver, bloated abdomen, or tympanitis, falling off of the hair, ab- 
scesses, boils, obstinate constipation, retention or suppression of urine, 
topical inflammations, dropsical swellings, etc. Most of these compli- 
cations are factitious, and owe their existence entirely to drug medica- 
tion, and are hence wholly unknown to the water-treatment. But as 
we are often called to patients who have been drugged, more or less, 
since the attack, we shall frequently have these incidents or accidents 
to manage. The stomach can generally be quieted by the free use of 
warm water, followed by bits of ice or sips of very cold water, and the 
cold compress externally. In a severe case apply also hot bottles to 
the feet and cold cloths to the head ; and if the head be very hot pour 
cold water on it for several minutes, until it becomes perfectly cool. 
Diarrhea may be checked by the hot fomentation or warm hip-bath, 
followed by cool or cold injections. Hemorrhages require the cold 
compress, cool or cold injections, and bits of ice or frequent sips 
of very cold water, with the hot foot-bath. Tympanitis requires the 
same treatment, with occasional hot fomentations. Abscesses and 
boils need nothing but the wet compress. When the hair inclines 
to fall off, it should be cut very short, and the head often wet with cold 
water, but not covered. Constipation is to be treated with tepid injec- 
tions, as copiously ns the exigency of the case demands. Difficult 
urination can generally be obviated by the fomentation or hot sitz- 
bath, or these followed by the cold compress, or a dash of cold water 
upon the pelvic region. In extreme cases the catheter must be em- 
ployed. Topical inflammations and dropsical swellings each require 
cold compresses frequently renewed. 

Relapses.^-! mention this subject only to contrast the condition of 
convalescent patients who have been through a course of allopathic 
drugging, with those who have had exclusive water-treatment. The 
former are always liable to relapses ; the latter never. 

Ephemeral Fever — Febris Ephemeris. — Some authors have dis- 
tinguished this fever into three species, acute, mild, and sweating; but 
the distinction is of no practical utility. 

Diagnosis. — Rigors slight, stages of short duration, mental functions 
scarcely disturbed, terminating in n few hours in a moderate sweat. 



FEVERS. 87 



The disease often disappears with a single paroxysm, and seldom ex- 
ceeds two or three. 

Special Causes. — A slight cold, an indigestible meal, a debauch, over- 
exertion. 

Peculiarities of Treatment. — The wet-sheet pack for an hour, fol- 
.owed by the dripping-sheet, or cold ablution, or free injection, with 
fasting for twenty-four hours, will always remove this kind of fever. 

Inflammatory Fever — Synochus. — The terms synocha and sy- 
noclius are employed quite promiscuously in medical books. Generally, 
nowever, a distinction is made, the former term being applied to what 
is usually denominated inflammatory fever, and the latter to a form of 
fever which is regarded as a compound of inflammatory and typhus — 
inflammatory in the commencement and typhus in the end. The 
truth is, these forms of fever are but different degrees in the violence 
of the same essential type, which may be called inflammatory or high 
fever, in contradistinction to typhus or low fever. 

Diagnosis. — This form of fever is rather peculiar to vigorous con- 
stitutions, and to persons of active, out-door habits of life. It may be 
distinguished from all others by th« following assemblage of symptoms : 
Tongue generally white with red edges, pulse full, hard, strong, and 
quick, though never very frequent. Temperature of the body uni- 
formly high after the fever is fully developed ; eyes reddish ; urine 
scanty and high colored ; the whole surface preternaturally flushed 
and turgid ; the mental functions but slightly disturbed, or not at all. 

If this fever runs much beyond the ninth day, or if it is maltreated 
at the outset, the tongue becomes yellow, then brown, then black, and 
many symptoms of an original typhoid supervene. Like all continued 
fevers it is characterized by two exacerbations during the day; the first 
and mildest in the forenoon, and the second and severest toward evening. 

Peculiarities of Treatment.- — Of this fever it has been well said : 
" The blood is on fire ; extinguish the flame, and the patient will be 
well." The hydropathic treatment is more simple and direct than in 
any other form of fever. Wrap the patient in double wet sheets, 
rightly covered with bedding ; let him remain as long as he is com- 
paratively comfortable ; then wash him oft* with cold water. Repeat 
the process as often as the febrile heat increases. The immersion- 
oath and pouring head-bath, as practiced by Mr. Millar, are peculiarly 
adapted to this form of fever. In fact, a sufficient quantity of cold 
water applied in almost any manner, will finally effect a cure. Usually 
the bowels are constipated in the outset; hence free injections of 
tepid water are necessary. 



88 PATHOLOGY AND THERAPEUTICS. 

Yellow Fever- — Typhus Icterodes — Synochus Icterodes. — 
Yellow fever is generally regarded as peculiarly contagious, though, I 
think, quite erroneously. Some authors, among whom are Dr. Good, 
have placed it among the remittents, on account of the peculiar re- 
mission which occurs during its progress. 

Characteristics. — Partial or general yellowness of the skin ; parox- 
ysms somewhat irregular ; great tenderness or pain about the epigas- 
trium, or pit of the stomach ; type irregular, which irregularity con- 
sists in a marked remission of the febrile symptoms, occurring during 
the first day or two, usually about forty-eight hours after their access. 
In severe cases the eyes are intensely red ; there is extreme pain in 
the eyeballs, back, and limbs. The black vomit, so alarming to friends 
and physicians, does not always take place, and when it does happen, 
I believe it is owiug more to mal-medication than to all other causes 
combined. 

Peculiarities of Treatment. — The excessive determination to the 
brain requires the constant application of the coldest wet cloths, or 
pounded ice, or the pouring head-bath. The stomach is usually ex- 
tremely irritable, and requires the cold compress. When retching or 
nausea is distressing, warm water should be freely drank for a short 
time, followed by sips of cold water, or bits of ice. The feet should 
also be placed in hot water for five or ten minutes. The bowels are 
usually severely constipated, hence a succession of warm water injec- 
tions should be promptly resorted to. The general treatment is the 
same as for inflammatory fever. 

Nervous Fever— Typhus Mitior.— This has been called "mild 
typhus," "low typhus, - ' and "slow fever." It usually runs from six 
to eight weeks under allopathic management. Some cases are attend- 
ed with such prostration of the nervous system, that the patient either 
sinks or becomes convalescent in one or two weeks. 

Diagnosis.— Great disturbance of the mental functions; dejection 
of mind; frequent, weak, irregular pulse; tongue covered with a 
white, thick mucus : eyes suffused ; heat of the surface more or less 
unequal ; frequent turns of muttering delirium ; countenance peculiarly 
expressionless ; the skin is liable to irregular dryness and sweats ; the 
early symptoms are mi.d, and increase in violence gradually ; the evac- 
uations are not particularly offensive ; the urine is commonly whey- 
like. 

Peculiarities of Treatment.— In the nervous form of typhus, the in- 
dications are rather to equalize irregular temperature and action than to 
reduce excessive. In son e cases the external heat is so high and 



FEVERS. S9 

uniform, as to call for the wet-sheet pack; but more frequently tlu 
morbid heat is pent up, as it were, in the head and epigastric region, 
while the extremities are either of the normal temperature or cold. 
Under these circumstances, the expectant plan of treatment, as it has 
been called, is the best. Apply cold applications to the head, cold, wet 
towels, often changed, to the abdomen, and bathe the feet in warm 
water, or apply hot. bottles to them ; and whenever, under this man- 
agement, the preternatural heat of the body becomes general, sponge 
the whole surface frequently with tepid water until the febrile heat 
subsides. Nausea, vomiting, and diarrhea are frequent incidents, and 
require the processes already frequently named for those symptoms. 

Putrid Fever — Typhus Gravior. — This is a more violent and 
malignant form of typhus than the preceding. Jail, camp, ship, hos- 
pital, and several other fevers, usually considered as distinct species, 
are but modifications of the putrid form of typhus, as influenced by 
local circumstances, and require no special pathological or therapeutic, 
notice. The spotted or petechial fever, so called from purple spots ap- 
pearing on the skin before death, has prevailed extensively in many 
parts of New England and New York since. 1806. It has been very 
fatal, and was formerly denominated typhus syncopalis, or sinking 
typhus. Medical books also make a useless and groundless distinction 
between tj^phus and typhoid fever, on the vague supposition that the 
atter has its seat more especially in a disease of the mesenteric and 
Peyer's glands. I reject this distinction as fanciful, if not puerile, and, 
as the reader will perceive, employ the terms typhus and typhoid in- 
discriminately. 

Diagnosis.*- Attack sudden ; progress rapid ; rigors severe ; early 
and great prostration of strength; extreme anxiety and restlessness; 
the countenance is expressive of anguish and horror ; pulse hard, but 
small and rapid ; tongue dry and brown or black ; the skin imparts 
more or less of a peculiar stinging, prickling, or burning sensation to 
the touch; the breath is hot and offensive; there is ringing in the 
ears; throbbing of the temples; intense headache; ferrety redness 
of the eyes; the excretions of urine and fceces are dark and offensive. 
In the advanced stage, spots or blotches appear on the skin from ef- 
fused blood ; forming petechia?, maculae, vibices, etc. There is great 
exhaustion of muscular power, and the face wears a livid instead of a 
florid flush. 

Peculiarities of Treatment. — Perfect quiet, and abundance of fresh, 
unconfined air are indispensable. The bowels should be promptly 
moved by tepid inje'ctions, to be followed by enema of cool water, to 



90 PATHOLOGY AND THERAPEUTICS. 

act as a tonic. In the early stages of a majority of cases of putrid 
fever, the morbid heat is sufficiently developed and uniform to demand 
the wet-sheet pack frequently repeated ; but it is generally necessary 
to apply hot bottles to the feet and cold compresses to the head at the 
same time. When the heat is too irregular, and the circulation too 
low for the full wet sheet, the abdomen should be frequently wrapped 
in wet towels, and the whole body very frequently sponged over with 
cool or cold water. In other respects, the rules already given are suf- 
ficient, to regulate the treatment. 

Remittent Fever.— Remittent fever is distinguished from contin- 
ued, by being attended w Jh only one daily exacerbation of the febrile 
paroxysm, instead of two; there is also a greater remission of all the 
febrile symptoms at the end of the paroxysm, though this remission is 
not complete as it is in intermittent fever. The remittent type of fever 
is common to hot climates, but rare in the temperate. It is also espe- 
cially prevalent in low, marshy districts, in the neighborhoods of stag- 
nant waters, in the vicinity of lands occasionally inundated, and in local- 
ities where the atmosphere is loaded with the effluvia of decaying ani- 
mal and vegetable matters. It is generally attended with great biliary 
disturbance, and in our southern and southwestern states it is often 
called- bilious remittent." Sometimes it is called "autumnal remit- 
tent," because it more generally prevails in the autumnal months. 

The neivous and putrid forms of remittent are distinguished by the 
same symptoms which denote the same forms of typhus fever ; a gen- 
eral disproportionate disturbance of the nervous S3"stem marking the 
former, and all the evidences of putrescency and extreme exhaustion 
manifesting the latter. 

All the general and special directions for treating the different forms 
of continued fever will equally apply to the same forms of remittent. 
It should be remarked that many cases of remittent fever — and the 
same is true of typhus fever — do not, on their first access, exhibit 
distinctly either the nervous or putrid type, although they always con- 
form more especially to one or the other as they progress. In all 
these cases, the character of the fever will approximate inflammatory, 
synochus, or high fever, and should be managed accordingly. 

Intermittent Fever — Ague and Fever.— Fever nnd ague 
seems to be especially connected with congestions in and functional 
derangements of the liver and spleen. Enlarged livers and spleens, 
called ague cakes, are very common sequelce of intermittents, although 
they are not unfrequently do jcted after protracted or repeated remit 



FEVERS. 91 

tents. What are called "chill fever" and "dumb ague," are disguised 
or imperfect'y-developed forms of intermittent. This disease is com- 
mon to miasmatic localities and new countries, where decomposing veg- 
etation abounds, and places where the dense foliage and stagnant waters 
fill the air wjth carbonaceous and hydrogenous gases, are much more 
subject to it. than those which have been longer under cultivation. It 
is very prevalent in many parts of our Western States ; and with the 
bad living which helps to produce it, and the huge doses of calomel, 
arsenic, and quinine given to cure it, a large proportion of those who 
"westward follow the star of empire," find their constitutions irretriev- 
ably ruined. 

Diagnosis. — The intermittent type of fever is readily distinguished 
by the violence of the paroxysm, the regular succession of the cold, 
hot, and sweating stages, <ind the complete subsidence of all the febrile 
phenomena at the end of the sweating stage, this subsidence amounting 
to a periodical intermission of the disease. 

Peculiarities of Treatment.- — Intermittent fever exhibits a variety 
of forms, as — quotidian ague, having an intermission about every 
twenty-four hours; tertian ague, the intermission about forty-eight 
hours; quartan ague, intermission about seventy-two hours: to which 
some authors add sub-varieties, called irregular and complicated. These 
distinctions do not affect the question of treatment. The bowels should 
be well cleansed with tepid injections, and when there is much nausea, 
or bitter taste in the mouth, a warm water emetic is advisable. The 
wet sheet, or the immersion, must be resorted to during the hot stage, 
and the pouring head-bath when there is great determination to the 
brain, with severe headache. During the intermission, a hot bath, 
followed by the cold drippiug-sheet, or cold shower, will generally 
soothe the nervous system, and mitigate the severity of the succeeding 
paroxysm. As the liver is always in a state of greater or less congestion, 
the abdominal bandage should be worn constantly. 

We find this disease under such diverse circumstances, and with so 
various complications, that there is room for considerable skill in its 
management. Recent cases are effectually cured by a few packs, or 
a single immersion, except when the causes have been a long time ac- 
cumulating. But frequently the liver or spleen is enlarged, or both 
may be in a state of congestion, and there is a dyspeptic condition 
attending it. Very often the skin is extremely torpid, and full of viscid, 
hardened, and impacted bile, the conjunctiva of a reddish-yellow, and, 
although sweating is easily produced, the real function of perspiration 
is scarcely performed at all. In these cases we may perhaps very 
goon "break the fits," but to effect a permanent cure, the functional 



92 PATHOLOGY AND THERAPEUTICS. 

actions of the liver, spleen, and skin must be established. Until this 
is done, the feverish and agueish symptoms will exist in a more or less 
disguised form, or the disease will exhibit some other irregular form, 
and constitute a predisposition to glandular enlargements, dropsical ac- 
cumulations, chronic and spasmodic rheumatism, etc. These cases 
require an active treatment for several weeks; and in some few cases, 
where the constitution has been shattered by repeated fevers in mala- 
rious districts, and more especially when the patient has been repeat- 
edly cured by arsenic, quinine, calomel, etc., several months' time are 
required to effect a cure. 

Regimen. — In continued and in remittent fevers, and in most other 
acute diseases, we have very little trouble abou* the diet, save keeping 
it away from the patient; nor much difficulty it. this vespect, for gener- 
ally there is no morbid appetite in the way. But with intermittent 
fevers, which may be regarded as chronic diseases with acute parox- 
ysms, the case is somewhat different. In those cases which linger 
several weeks, we must, of course, look to the nutritive function. 
Here we have not unfrequently to restrain the dyspeptic's craving for 
accustomed stimulants, the hypochondriac's rage for excessive quantity, 
and the epicure's goading desire for tit-bits and seasonings. We cannot 
turn the patient off "old-school" fashion, with, "Eat and drink what, 
you find agrees best," and draw on the apothecary for the curatives, 
but it is our business to know exactly what will agree best, and so pre- 
scribe " according to knowledge." 

The best diet is wheat- meal bread, cracked-wheat mush with a very 
Utile milk and sugar for seasoning, a very moderate quantity of th«) 
milder vegetables, and the free use of good, ripe, sweet apples, eitner 
baked or boiled. Grapes, tomatoes, prunes, and good dried fruits, are 
not objectionable. The crust of good sweet bread, and dry toast, or 
hard crackers, are excellent to improve the salivary and gastric secre- 
tions. 

Water should be drank rather freely, on account of the tendency to 
waste the serum by perspiration. Exercise should always be moderate. 
Over-exertion during the intermission always aggravates the subse- 
quent paroxysms. Sailing and carriage-riding are the most advanta- 
geous exercises. 

Symptomatic Fever*. — These are treated on general principles 
as far as the constitutiona disturbance is concerned, reference always 
being had to the primary affection. As ihey depend on a local patho- 
logical condition, they will be particularly considered under the heads 
of the idiopathic diseases, of wh'jh they constitute the symptoms. 



FEVERS. 93 

Small-Pox — Variola.- — The small-pox is a contagious eruptive 
fever, affecting both the skiu and mucous membrane of the mouth, 
throat, stomach, and lungs. Its access is a fever; this is followed in 
three or four days by an eruption, which is papular at first, then ve- 
sicular, and lastly pustular; the pustules are pointed at first, but after- 
ward become umbilicated. The eruption terminates in twelve to 
seventeen days in dessication and scabbing, leaving larger or smaller 
irregular cicatrices. 

Species. — This disease appears in three forms: 1. Distinct small- 
pox — variola discreta. 2. Confluent small-pox — variola confluens. 3. 
Modified small-pox — varioloid. The first variety is the mildest; the 
eruption is regular, the vesicles distinct, and the fever of the inflam- 
matory type. The second variety is the most severe ; the vesicles are 
irregular and mixed, and mature imperfectly, and the accompanying 
fever is typhus. The third variety is the small-pox as modified by 
vaccination, or a previous attack. 

Stages- — The phenomena of variola are divided into four stages : 1. 
Incubation, or the latent period ; being the time that intervenes between 
the inception of the virus and the first appearance of the symptoms. 
This period varies from six to twenty days. 2. Invasion, which extends 
to the eruption, usually three or four days. 3. Eruption, the vesica- 
ting and pustulating period, extending to the eleventh or twelfth day. 
4. Dessication, extending to the time of cicatrization, usually about 
the seventeenth day. The time from the third to the eighth day, 
during which the papute change to pustules, is called the period of 
maturation. 

Symptoms of Distinct Small-Pox. — The attack is characterized by 
the usual premonitory symptoms of a violent fever, as chills or rigors, 
lassitude, headache, pain and weakness in the back and loins, tender- 
ness about the pit of the stomach, frequent nausea and vomiting, 
drowsiness, sometimes stupor, or coma, and with infants convulsions 
are frequent occurrences. These symptoms are succeeded by general 
heat of the body, diy skin, coated tongue, frequent pulse, and extreme 
restlessness, which continue until the eruption appears, when they 
partially subside. 

The eruption appears first on the face and forehead, in the form of 
minute spots or papuke, sensibly elevated above the surface of the skin. 
They are first noticeable about forty-eight hours after the occurrence 
of the rigors. During the third and fourth days the eruption extends 
to the sides of the nose, chin, upper lip, neck, and wrists, then to the 
trunk and thighs, finally covering the whole body. About the fifth 
day, little vesicles, depressed in the : cater, containing -a-colorless- fluid, 



94 PATHOLOGY AND THERAPEUTICS. 

appear, surrounded by an inflamed circular margin, one vesicle arising 
on the top of each little point or pimple. Usually the eruptive fever 
further abates, or entirely disappears at this time. There is generally, 
though not always, an increased flow of viscid saliva, some swelling of 
the throat, with hoarseness and difficulty of swallowing, about the 
sixth day. 

On or about the eighth day, the pustules are completely formed and 
spherical, terminating in a point, and the vesicular fluid becomes puru- 
lent; the face and eyelids swell, and the mouth, nose, and fauces are 
covered with pustules. About the tenth or eleventh day from the 
access of the fever, or eighth or ninth from the appearance of the 
eruption, tho inflammatory areola surrounding the vesicle subsides, the 
contents change to an opaque yellow, and a dark spot appears on each 
pustule. Usually at this time the tumefaction of the face subsides 
and the hands and feet begin to swell. After the eleventh day the 
pustules become rough, break, discharge their contents, which, by 
drying on the surface, form small crusts. In a short time these crust? 
fall oil', leaving the part of a dark brown color, which often remain? 
many days, and when the pustules have been very large, permanent 
indentations of the skin remain. About the seventeenth day, the sec- 
ondary fever, which conies on about the completion of the pustulation 
disappears, and the swelling of the hands and feet, subsides. 

Symptoms of Confluent Small-Pox. — The eruptive fever is more 
intense, the strength is greatly prostrated, coma and delirium are fre- 
quent, and profuse diarrhea or salivation is often present. The eruption 
is preceded by an erysipelatous efflorescence upon the face, from 
which the pustules emerge on the second day, in the form of small 
red points, which run together, and form clusters, resembling measles. 
The pustules are irregularly shaped, and contain a dark, ichorous mat- 
ter, instead of true pus. When the crusts begin to form, the whole 
face is covered with a general scab, which fails off from the fifteenth 
to the twentieth day. The fever does not cease upon the appearance 
of the eruption, but about the ninth day suffers a remarkable exacerba- 
tion; in very bad cases, the eruption becomes livid or black, and pe- 
techia, hemorrhages, bloody urine, and exhausting diarrheas occur. 
'Should recovery take place, the pits or scars will be much deeper than 
in the preceding form. The patient frequently dies about the eleventh 
day. 

Sym2>to?ns of Modified Small-Pox. — The eruptive fever, though 
generally severe, usually lasts but a single day. On the following day 
the eruption appears; first on the wrist and about the nose. Frequently 
a pimple on tho ala of the nose gives an indication of the nature of 



FEVERS. 

the malady. The course of the disease is shorter, and the symptoms 
more irregular than in the other forms. Some of the eruptions pro- 
gress to perfect pustules; others die away without suppurating. As 
soon as the eruption appears, the patient is well, unless it is sufficiently 
extensive to keep up some degree of irritative fever. 

Diagnosis. — The diseases with which small-pox is liable to be con- 
founded, especially in its early stages, are — Chicken-pox — varicella; 
measles — rubeola ; scarlet fever — scarlatina ; and erysipelas. Variola 
may be distinguished from chicken-pox b; '.he pimples appearing on 
the back, the maturation of the pustules on the third day, and the ab- 
sence of suppuration and indentation, whicti characterize the latter dis- 
ease ; from measles, bj- the hoarseness, moaning, swelled eyelids and 
watery eyes, which attend the attack of measles, and the eruption 
appearing in crescentic clusters, not rising into visible pimples ; from 
scarlet fever, by the strawberry appearance of the tongue, and the 
bright scarlet efflorescence of the skin, which usually appears on the 
second day in the latter disease; and from erysipelas, by the eruption 
or efflorescence being of a florid red color, and spreading from a par- 
ticular point over a large surface, in the case of erysipelas. 

Prognosis. — The result may be judged of by the condition of the 
body at the time of attack, and the intensify of the fever. It is 
generally favorable in the distinct and modified forms, and generally 
unfavorable in the confluent form. Dangerous symptoms are the pus- 
tules becoming flattened, livid, and interspersed with discolored spots, 
a sudden disappearance of the eruption, general pallor of the skin, 
with great anxiety and extreme prostration of strength, and complica- 
tions with local affections. 

Post- Mortem Appearances. — After death, dissection has shown the 
windpipe, bronchial vessels, lungs, live) - , stomach, and intestines to be 
covered with pustules, with local inflammations in various organs; the 
whole body runs rapidly inlo putrefaction. 

Causes. — Variola is produced by a specific contagion. Its nature 
has thus far eluded the recognition of our senses, and probably never 
will be detected by chemical analysis. The virus seems to act like a 
ferment in relation to some one or more of the elements of the blood, 
analogous to the process of saccharine fermentation. It is produced 
by subjecting the body to the effluvia arising from those who already 
labor under the disease, or by introducing a small quantity of the puru- 
lent matter of the disease into the system by inoculation. A doctrine has 
lately been started that the changes efl'ected in the blood by the conta- 
gion of small-pox were a purifying process, analogous to the working 
y{ a barrel of beer. But the theory is refuted by the fact that all fer 



SG PATHOLOGY AND THERAPEUTICS. 

mentation is a destructive process, absolutely decomposing the saccharine 
and other fermented matter, and resolving it into its ultimate elements. 

Laws of Contagion. — It is communicated by contact, or through the 
atmosphere, by pustules, or substances imbued with the variolous mat- 
ter, and equally by the living or dead body. It is occasionally epidemic. 
Sometimes, though rarely, it occurs twice in the same person. 

Mortality. — From the statistics which have been collected, it appears 
that ene in three or four cases are fatal. In the modified form, or in 
those who have beet) vaccinated, the mortality has been much less — 
about one in twenty. The periods of life of its greatest mortality have 
been under five and over thi*ty years of age; the ratio increasing below 
and above those ages, and being the least between them. 

Sequela. — Medical books describe a long catalogue of diseases as the 
consequences of small-pox, some of which are more to be dreaded 
than the disease itself. Among these are boils, abscesses, ulcers, gan- 
grene or sloughing of the skin, erysipelas, suppuration of the joints, 
hip disease, ophthalmia, blindness from opacity of the cornea, inflam- 
mation of the serous membranes of the chest and abdomen, tuberculated 
'ungs, consumption, mesenteric disease, and scrofula. Some of these 
iequete doubtless result from frail organization, more from bad habits 
ot living, and still more from unfortunate medical treatment. 

Prevention. — Physicians are not at all agreed as to the propriety of 
resorting to vaccination as a protection from small-pox. The vaccine 
virus is the variolous matter modified by passing through the organism 
of the cow, or some other of the domestic animals ; hence the disease 
resulting from its introduction to the human system is called vaccinia 
or vacciola, coio-por, kine-pox, and vaccine disease. There is no ques- 
tion that it is, to a great extent, a protection from the violence and 
clanger of the natural smail-pox ; at the same time there is danger of 
inoculating the patient with some loathsome and even worse disease, 
as venereal, or scrofula, from the impossibility of always getting a sup- 
ply of vaccine matter from healthy constitutions. In either way there 
Is a risk to incur, and it is a delicate ri.ntter for a physician to advise on 
a subject when both sides are hazardous. I am fully convinced that 
if people could bring up their children in strict physiological habits, 
the non-vaccinating plan would be altogether the best ; but in a city 
this seems next to impossible, and in the country it is pretty generally 
neglected. Children reared healthfully in relation to food, exercise, 
and ventilation, have little to fear from any disease, however contagious; 
they ma}' have this, but it will not endanger life, nor produce much 
deformity nor serious injury. I have seen, within tne last year, a most 
horridly loathsome case of scrofulous disease, in which the. patient 



FEVERS 97 

lneitiily rotted alive at the age of fifteen, from unhealthy virus received 
wnen he was but three years of age. Parents often find some one 
of their children tainted with morbid humors, uniike any other mem 
ber of the family, and which they are wholly unable to account for, 
except on the supposition of foul matter taken into the system by 
vaccination. My own practice would be to keep children as healthy 
as possible, and if the small-pox happen along, let it have its natural 
course. Those who have the means to do the same I would advise to 
act accordingly, while those who live, move, eat, and drink after the 
ordinary manner, would have a better chance at chances by resorting 
to vaccination. 

Treatment. — As in all fevers, whether eruptive or not, the tempera- 
ture of the body is the guiding principle in the treatment. To regulate 
the temperature and equalize the circulation, are the leading indica- 
tions. On the access of the febrile symptoms, the bowels, unless en- 
tirely free, should be moved by tepid injections. When the fever is 
fully developed, if the heat is not great, tepid or cool ablutions to the 
whole body will moderate it sufficiently; if the fever is severe, and the 
heat extreme, the wet-sheet pack should be resorted to, and resumed 
as often as it becomes warm, until the skin becomes soft, and the tem- 
perature near the natural standard. Give the patient as much water 
to drink as the thirst demands. Give no food save Indian or wheat- 
meal gruel, and not that unless the appetite calls for it. Nursing chil- 
dren mny take the breast as usual, if inclined. From the second to 
rhe fourth day, when the efforts of the organism are determined to the 
^kin to produce the eruption, be cautious in meddling with the stomach 
And bowels. Thousands have been killed outright by an emetic or strong 
purgative administered at this critical period. At this time all the vital 
energies are aroused to throw the virus off through the surface, and 
if, by an irritating emetic or cathartic, this action be repressed, and the 
force or the disease directed to the stomach and bowels, death may be 
the speedy result. The principle here involved affords a satisfactory 
explanation of the superior safety of the homeopathic treatment, com- 
pared with allopathic, in all eruptive fevers, as has been frequently 
demonstrated in practice in the management of scarlet fever. 

After the excessive febrile heat is subdued by ablutions or packings, 
two cool or tepid ablutions daily, morning and evening, will generally 
be sufficient through the whole course of the disease. Should the ex- 
tremities at any time become cold, bottles of hot water should be 
applied. There is often a strong determination to the brain, evinced 
by headache, delirium, convulsions, etc., when cold wet cloths should 
be applied. 

11—9 



08 PATHOLOGY AND THEE APEUTICS. 



The secondary fever required precisely the same medication as »)v» 
primary, though if the former has been well managed, the latter give* 
but lit lie trouble. 

Ventilation is specially important ; the patient should be kept in a 
large, well-aired room, of even and rather cool temperature. 

Various expedients have been tried to mitigate the itching that often 
attends the dess;cation of the pustules, as well as to prevent, pitting or 
scarring. None have, however, been found of much service. Washing 
the sores with to.d cream is as harmless, and probably as useful, as 
any thing which has been suggested. 

JSote. — The symptoms of small- pox, in the above article, are stated 
as they occur in patients .whose habits of life pattern after the usual 
fashions of society. The hydropathic practitioner will often find them 
very materially modifie I in persons who have for a considerable time 
been accustomed to a hydropathic regimen, especially in children who 
have been trained on the principle of "eating to live," instead of that 
of "living to eat." Indeed, in such cases many of the symptoms laid 
down in medical books as characteristic may be entirely wanting. I 
have a case at this writing under advisement, which strikingly exem- 
plifies the difference between an eruptive fever occurring in a very 
healthy or a very unhealthy person. 

Under judicious water-treatment, this frightful disease becomes di- 
vested of most of its terrors, and there is little danger, except in a per- 
son of extremely gross habits and foul blood, of the skin being perma- 
nently pitted or scarred. 

Cow-Pox — Kink-Pox- -Vaccinia — Vaccine Diskask. — The vac- 
cine matter ia usually inserted 'inder the cuticle, by three or four 
punctures, in one or both arms. On the second day small, red, hard 
spots appear, which increase sensibly on the fourth, and on the fifth 
become small pearly vesicles, soon after surrounded by a pink or crim- 
son flush. On the seventh or eighth day the areola becomes circular 
or angular, and about an inch in diameter. The vesicle is uneven, 
with a central depression. On the ninth day the flush is increased, 
hard, and tumid, often attended with an erythema over the arm or 
whole body. About the tenth day there is a slight febrile paroxysm. 
On the eleventh or twelfth day the redness diminishes, the center of 
the vesicle is covered with a brown scab, which comes off about the 
twentieth day, leaving a deep, circular indentation, about an inch in 
diameter, with as many , its as there were cells in the vesicles. 

Tho vaccine virus is usually selected from the fifth to the twelfth 
day. 



FEVERS. 99 

This disease requires no medication, save what s due to personal 
cleanliness, and "temperance in all things." 

Chicken-Pox — Swine-Pox — Bastard-Pox— Varicella — This 
disease is characterized by slight feverishness, followed, w'fhin twenty- 
four hows, by an eruption of small, reddish pimples, appearing first on 
the back, very much resembling the first appearance of the eruption 
of small-pox. On the second day, the pimples become small vesicies 
filled with a colorless or yellowish fluid ; soon after a thin scab forms 
at the top, without pus. About the fifth day the eruption disappears, 
without leaving any mark or cicatrix. 

A daily wash of the whole surface of the body, with one or two 
wet-sheet packs, should there be at any time accidental feverish- 
ness, with a spare vegetable diet, is all the remedial attention it 
requires. 

Measles — Rubeola — Moreilli. — Nosologists divide this exan- 
them into two species, the common and the malignant — rubeola vul- 
garis and rubeola maligna. The first species is the mild form ; the 
second is the violent. 

Symptoms. — The early symptoms resemble catarrh, or influenza — 
cough, hoarseness, difficulty of breathing, frequent sneezing, itching 
of the face, smarting of the eyes and eyelids, nausea, thirst, etc. The 
eruption first appears on the fourth day, consisting of small red points 
on the face, thence extending downward over the body. These points 
do not rise into visible pimples, but are disposed in crescentric clusters, 
which feel a little prominent to the touch. On the fifth or sixth day 
the bright red color changes to a brownish hue? and in a day or two 
more disappears entirely with a mealy or furfuraccous desquamation 
of the cuticle. 

The fever rather increases with the eruption, and is attended with 
pneumonic symptoms, as cough, soreness of the chest, and oppressed 
respiration. It usually abates considerably at about the end of the first 
week. 

In the malignant form the eruption is earlier and more irregular, 
often receding and re-appearing, and of a dark or livid hue. The 
febrile symptoms are more severe, the abdomen is very tender, the 
head is delirious or comatose, the lungs are inflamed, and diarrhea and 
convulsions ofter occur. 

Peculiarities ,./ Treatment. — The mild form should be treated on 
precisely the same plan as simple inflammatory fever, and the malig- 
nant form should be managed exactly like typhus fever of the putrid 



100 PATHOLOGV AND THERAPEUTICS. 



type. Nothing brings out the eruption so promptly and effectually 1 aa 
the wet-sheet pack, and at the same time moderates all the symptoms 
of violent disorder in the circulating and nervous sytems. When the 
eruption comes out full and free, and the fever is not violent, occasional 
tepid ablutions are sufficient. When there is much soreness of the 
throat, several folds of wet linen should be applied. Severe cough, 
pain in the chest, or inflammation cf the lungs, requires the chest- 
wrapper, applied very wet, and well covered with dry flannel. Diarrhea, 
when present, should be treated with cool injections. 

Sequela. — Under allopathic treatment, this disease exhibits an appall- 
ing catalogue of consequences, as — Pneumonia, cynanche trachealis, 
bronchitis, consumption, chronic diarrhea, enlargement of the mesenteric 
glands, ophthalmia, abscesses in the ear, ulceration of the parotid glands, 
apthce and gangrene of the mucous membrane cf the mouth. I appre- 
hend that these sequelae are to be attributed, in the main, to the drug- 
ging by which one poison is atttempted to be got out of the body by 
the introduction of a dozen others. It is certain that measles has 
been extensively treated in many different places in the Water-Cure 
way; and I have never yet known nor heard of a single death, nor 
of one of these resultant diseases. 

Scarlet Fever — Scarlatina. — This exanthem appears in three 
distinct forms or species : 1. Scarlatina simplex, — simple scarlet fever. 
2. Scarlatina anginosa. 3. Scarlatina maligna. 

Symptoms. — After the ordinary premonitory symptoms of general 
fever, a bright scarlet efflorescence appears, usually on the second day, 
first on the face, neck, and breast, extending downward over the trunk 
and limbs. .*.t first the eruption consists of innumerable red points, 
between which the skin exhibits the natural color; these spots finally 
coalesce, so that in a few hours the red flush is universal. On pressure, 
the skin looks pale, but readily recovers its redness when the pressure 
is removed. In one or two days more the efflorescence again becomes 
partial, and is disposed in large, irregular patches, which do not disap- 
pear on pressure. The skin feels rough to the touch, and is occasion- 
ally studded with small miliary vesicles, v About the fifth day the rash 
begins to decline, is indistinct on the sixth, and generally disappears 
wholly by the eighth. Desquamation of the cuticle commences about 
the end of the fifth day on the parts first affected, now extending over 
the body* On the trunk and 'imbs the cuticle comes off in the form 
of scurf, and from the hands and feet in large scales. At this time the 
mucous membranes are more or less affected. The eyelids, lips, ed°-es 
of the tongue, nostrils, and palate exhibit a bright red color, the tonsils 



FEVERS. 101 

are enlarged, and there is difficulty in swallowing. The fever disap- 
pears with the rash. 

Such is scarlet fover in its mild form. The anginose variety is 
characterized by more severe general symptoms, dejection of mind, 
pain in the head, soreness and stiffness of the muscles of the neck. 
On the second day, hoarseness, difficulty of swallowing, hurried breath- 
ing, interrupted by frequent sighing, breath hot and burning to the lips, 
heat of the surface very great, weak and frequent pulse, pungent, 
prickling pains. On the third day the face, neck, and breast appear 
redder than usual, or scarlet patches appear about the mouth and nose. 
The sub-maxillary glands are enlarged and painful, the palate, tonsils, 
and pharynx are reddened, specks and collections of thick mucus aie 
observed about the mouth and throat. In a few hours, an intense red 
ness prevails over the whole body, which is perfectly smooth to the 
touch. On the fifth or sixth day the deep scarlet is succeeded by a 
brown color, the skin becomes rough, and peels off in small scales. 

The malignant form has been extensively known by the name of 
putrid sore throat. It is distinguished by intense inflammation of the 
throat at the outset, soon proceeding to deep ulceration and extensive 
sloughing. All the salivary glands are much enlarged, the eruption 
appears later in irregular patches, often disappearing suddenly. The 
general symptoms are all indications of the worst or putrid form of 
typhus fever. 

Diagnosis. — Scarlet fever may be distinguished from measles, by 
the absence of cough, sneezing, and catarrhal symptoms; by the throat 
affection; by the peculiar strawberry appearance of the tongue, and by 
the greater extent and less defined form of the eruption. 

Sequela. — The books give us about as terrible a list of diseases follow- 
ing on as the sequela? of the scarlet fever, as they do in the case of mea- 
sles. In the list are — Anasarca, or general dropsy, enlargements of the 
joints, scrofulous affections, discharges from the ears, ulceration of the 
glands of the neck, ophthalmia, and inflammatory affections of the in- 
ternal viscera. But, as in the case of measles, I regard these conse- 
quences as owing much more to maltreatment than all other causes 
put together. 

Peculiarities of Treatment. — The melancholy records of medica* 
science afford on no page a stronger exemplification of 

" The deadly virtues of the healing art," 

than on that whereiu is written the management and fatality of scarlel 
fever. One, two, three, four, five, and even six members of a family 
are sometimes successively attacked anc successively die — whether cut 



102 PATHOLOGY AND THERAPEUTICS. 

down by the disease, or killed by tbe remedies, or hurried to the grave 
by their combined power. Some iozen years ago, I knew a regular 
physician to treat his three children — all he had — with the ordinary 
leeching, puking, purging, and antimonializing routine, and they all 
died ; and I have not the least doubt he has treated all the cases he 
has had in the same way ever since, without even the suspicion that 
there was any possibility of a better way. About fifteen years since 
the disease prevailed epidemically among children in several places in 
western New York. I happened to be acquainted with two physicians 
residing in adjoining towns, whose practice was somewhat different. 
One bled freely, and gave liberal doses of purgative medicines. He 
lost about twenty patients ; in several instances two, and in two in- 
stances three dying out of one family. The other bled only in a few 
of the milder cases, avoided all drastic purgatives, confining his treat- 
ment mostly to gentle laxatives, simple diaphoretics, and astringent 
gurgles. This physician lost but one case, although he.treated a larger 
number than the former one. Both physicians had their particular 
friends and admirers, and I have no manner of doubt the doctor who 
lost twenty patients acquired just as much reputation as a skillful prac- 
titioner, and enjoyed just as much of the confidence of the people, as 
the doctor who lost but one patient; so blindly are people wedded to a 
routine in which they have been educated. 

The mild form requires very little treatment. Occasional ablutions 
of tepid water, or the wet-sheet pack once or twice a day, if the fever 
is high, with a free injection of warm water to clear the bowels, if the 
abdomen is constipated, swelled, or painful, are sufficient. 

Both the anginose and malignant forms require ca-eful manage- 
ment. Employ the wet sheet, ablutions, or tepid sponging, according 
to the principles already stated. The feet generally incline to be cold, 
and particular care must be taken to hrwe them warm and comfortable 
whenever the pack or any general bath is resorted to. Hot bottles or 
hot foot-baths answer this purpose. The throat is the most endangered 
part; in the anginose form, ti.e swelling must be treated with the 
constant application of cold wet linen cloths, well but loosely covered. 
In the malignant, or ■putrid form, the coldest water, or pounded ice, 
thouid be frequently applied around the neck, and sips of iced-water 
W bits of ice occasionally taken into the mouth. On the access of the 
lisease move the bowels moderately with warm wafer injections, aided 
Ay the drinking of warm water or gruel, if necessary. Whenever 
diarrhea attends, employ cold enema. Be careful and not disturb the 
atomacl) and bowels during the eruptive effort. If there is then great 
rckness or nausea apply very cole 1 , compresses to the abdomen. Ex- 



FEVERS. x 03 

cessive restlessness, anxiety, delirium, or violent headache may be best 
relieved by a hot foot-bath, with a cold compress to the head, or, if the 
patient is able to sit up, a warm hip bath. 

There is often a considerable degree of blindness and deafness, as 
well as di ficult respiration, attending the swelled throat; and physicians 
and friends will often, for these particular symptoms, insist on a little 
leeching, or a mild emetic, or a smart cathartic, or a barbarous blister. 
They are all bad, worse, or worst. There are states and stages in a 
severe case of scarlet fever, in which a single dose of an ordinary 
emetic or purgative, or a single bleeding, would be inevitably fatal; and 
it is to be regretted that so few physicians can or will understand this 
fact. In scarlet fever, as in all the exanthemata, there is a period when 
all the vital powers combine in a general effort to throw the morbid 
virus and febrile irritation upon the surface. It is at this precise time 
that the allopath regards the intensity of the fever as an indication for 
the lancet, or a relaxing emetic, or a depleting purgative. If he em- 
ploys either of them at this critical moment, he either suppresses this 
effort, or produces a revulsion of the whole force of the disease to tlio 
internal mucous membrane, resulting, perhaps and probably, in inflam- 
mation, disorganization, and death. 

Dr. Johnson, in relation to the diet for scarlet fever patients, says : 
"If there be appetite, farinaceous puddings should he given; if not, 
b?ef-tea, mutton-broth, gruel, barley-water, etc. Should the eruption 
come out languidly, and symptoms of great debility and oppression set 
in, no cold water should be allowed, but the mutton-broth, etc., should 
be given quite hot ; and ten, fifteen, or twenty drops of aromatic spirit 
of ammonia, in water, twice a day; and hot tea should lie administered 
while lying in the wet sheet." I protest against, this whole plan of 
medication as being neither hydropathic nor rational. Nothing can bo 
more preposterous than forcing food, especially stimulating animal 
slops, into the stomach, during a high fever, when the digestive powers 
are utterly prostrated. In lieu of the hot tea, hot broth, and hot spirit 
recommended by Dr. Johnson, the warm foot bath, or hot fomentations 
to the abdomen, wiM, in the case supposed, supersede all necessity of 
employing these slop-drug preparations, as has been abundantly proved 
in the thousands of cises of this fever which have been successfully 
treated by American hydropaths, without, as fir as I have heard, los- 
ing a single case when no drugs or animal slops were employed. 

Erysipelas — St. Anthony's Fire. — This affection has been di- 
vided into idiopathic erysipelas, produced by the. general causes of ffver, 
and trauma '.h: erysipelas, resulting from wounds and injuries. The 



104 PATHOLOGY A X D THERAPEUTICS. 

latter species frequently follows surgical operations performed on per- 
sons whose systems are gross, and whose blood and secretions are very 
impure. For therapeutic purposes these distinctions are unimportant. 

Symptoms. — After the usual febrile chills, nausea, vomiting, etc., the 
patient is affected with great confusion of the head, amounting often to 
delirium or coma; the tongue is moist, and uniformly white ; the pulso 
full, frequent, and compressible. About the second or third day, some 
portion of the skin exhibits a florid red color, from which the efflores- 
cence spreads gradually, being bounded by a distinct margin, slightly 
elevated. The efflorescence extends until it occupies a large surface, 
attended with considerable swelling, and a peculiar acrid heat of the 
inflamed parts. When the face is the part principally affected by the 
efflorescence, the eyes are often closed by the swelled eyelids, and the 
whole hairy scalp is more or less inflamed. The efflorescence termi- 
nates in a few days, the time varying considerably, in the formation of 
vesicles, or in desquamation of the cuticle. The fever has the usual 
daily exacerbations of the continued type, but rarely manifests any 
marked remission until the eruption teases to spread, from which time. 
in favorable cases, convalescence commences. 

Special Causes. — No two diseases are more intimately connected 
with bad dietetic habits than erysipelas and scarlet fever. Both are 
very prevalent where swine-food, greasy sweet-cakes, and concentrated 
preparations of food are plentiful. Sudden changes of temperature 
operating on a system inflamed by gross or obstructed by constipating 
aliment, seem to be the principal circumstances on which these forms 
of eruptive fever depend. 

Occasional Terminations. — This disease, medical books tell us, often 
terminates in a dropsical swelling — erysipelas ademawdes ; deep-seated 
ulceration of the cellular membrane — erysipelas gangrenosum, metas- 
tases to internal organs ; and sometimes it suddenly disappears in one 
part, and attacks a distant one — erysipelas erraiicum. These sequela-, 
however, like those of all the other exanthemata, are, to a much 
greater extent, attributable to injudicious treatment, or drug-treatment, 
than to all other causes combined. 

Peculiarities 'of Treatment. — As in the case of all the other eruptive 
fevers, the general fever and the local inflammation may exhibit, all 
degrees of violence and malignancy, from the mildest form of synochu?, 
or inflammatory fever, to the most virulent character of typhus ; hence 
the circumstances already noticed in relatirn to those fevers must be 
regarded in the treatment of this. Generally, the head requires the 
very free application of the coldest wet cloths, or the pouring head- 
bath ; and very frequently '.he feet are coo or cold, and require the 



FEVERS. 105 

warm bath. In the early stages of most cases, two ^.r three wet-sheet 
packs a day are desirable; but when the fever is strongly typhoid, the 
pulse weak, the circulation low, and' the heat irregular, it is better to 
sponge the whole surface frequently with tepid water. Tepid injections 
should oe employed freely on the access of the disease, but not resorted 
to during the eruptive stage, on the second or third day, unless there 
is manifest fullness and distension, indicative of fcecal accumulations in 
the bowels. 

Dr. Johnson advises, in this disease, the wet sheet occasionally, and 
a nitrate of silver wash, or a coating of flour to the skin, a dose ot 
castor oil, and then quinine and sulphuric acid once in six hours. Such 
treatment is sufficiently absurd, coming, as it does, from the author of 
a book on "Domestic Hydropathy;" but the absui'd becomes the ridic- 
ulous when we come to Dr. Johnson's dietary part of the treatment, 
viz.: Strong beef-broth, thickened with pearl barley; yolk of eggs 
beaten up with milk, and a little wine and nutmeg added ; sago, with a 
little wine in it; cold beef-tea, or cold mutton-broth, as common drink." 
The only way to reconcile Dr. Johnson's extreme allopathic treat- 
ment of this fever, with his extravagant encomiums of the superior 
efficacy of water-treatment in all fevers, in a preceding work, is by 
supposing he never had any experience in treating erysipelas with 
water; and hence, as something must be prescribed, he naturally falls 
back on druggery. His reasons for introducing the drug-treatment 
here are completely self-stultifying. He says : "The weight of expe- 
rience is in favor of quinine, and I should not consider myself justifiable 
in rejecting its aid, merely to gratify the pride of an exclusive practice. 
* * * Human life is too precious a thing to be trifled with merely 
to satisfy an impertinent whim, or foolish enthusiasm." 

Now, if the principle implied in the above quotation is correct — if it 
be true that drug-treatment will save life in a fever where water-treat- 
ment would sacrifice it, the whole hydropathic system is one grand 
mistake, and its practice mere charlatanry. But if the exact contrary 
be the truth, as I hold, then Dr. Johnson's druggery, in scarlet fever 
aud erysipelas, is considerably worse than scientific nonsense. Amer- 
ican water-doctors find the new system as all-sufficient in these as in 
all other forms of fever. None of them, however, to my knowledge, 
have ever administered the execrable slop-grog food, of eggs, wine, 
nutmeg, mutton-water, etc. I would rather trust the patient with no 
medication whatever, than with the best water or drug-treatment, in 
connection with such a regimen as Dr. Johnson recommends. 

Miliary Fever — Miliaria. — This disease takes its name from the 



106 PATHOLOGY AND THERAPEUTICS. 

resemblance of its vesicles to the grains of millet. Some authors group 
a variety of similar rash-exanthema under the general term of miliaria. 
An eruption similar to that of miliary fever often appears in the course 
of other acute diseases, when the patients have been kept in hot, un- 
ventibited apartments, or dosed excessively with hot stimulating drinks. 
Lying-in women are peculiarly liable to this miliary eruption, under 
the usual erroneous management of their medical advisers. This fever 
occurs most frequently in those females who use tea excessively ; it 
often attacks children who have been accustomed to hot drinks and ali- 
ments; and old persons whose blood is inflamed, and whose nerves are 
exhausted by acrid stimulants ana narcotics — as cider, tobacco, etc. — 
are quite liable to it. 

Symptoms. — With the ordinary accessory symptoms of fever, there 
is laborious breathing, frequent sighing, great debility, depression of 
spirits, restlessness, wandering pains, followed sooner or later by a 
profuse sweat, of a sour, rank odor, accompanied with a troublesome 
itching or pricking of the skin. The sweat may appear in two, three, 
four, jive, or six days. At length, at an uncertain period, an eruption 
appears on the neck and breast of small red papute, about the size of 
millet-seeds, these gradually extend downward, over the trunk and 
extremities. The pimples do not become prominent to the eye, yet 
feel elevated to the touch. Often their redness disappears, leaving 
them of the color of the skin. After ten or twelve hours, a small ves 
icle appears upon the top of each papula, at first of a whey color, 
usually turning gradually white. Sometimes the vesicles remain red, 
and sometimes red and white vesicles are intermixed, but always have 
a strong, rank, offensive smell. In two or three days more the vesicles 
break, and are succeeded by small crusts, which soon fall off in scales. 
The febrile symptoms do not subside when tihe eruption appears, but 
after a variable interval. 

Diagnosis.— Miliary fever is easily distinguished from all others by 
the profuse sweating attended with the fetid odor, and this being fol- 
lowed by the peculiar eruption. 

Peculiarities of Treatment. — As miliary fever is attended with un- 
usual debility in its early stages, cool or tepid applications are preferable 
to very cold. Hot or cold local applications, according to the rules 
often heretofore adverted to, with frequent sponging of the whole 
surface, according to the degree of general heat, are usually all the 
bathing appliances required. Unless there is diarrhea, the bowels 
should be freely moved by tepid injections at the outset. Local pains 
should be promptly treated with the cooling 01 warming wet compress, 
as either feels most agreeable to the patient When this fever haa 



FEVERS. 107 

been produced by the suppression of any custo nary discharge, warm 
hip and warm foot-baths are serviceable. 

Note. — Some authors treat of "gastric," "mucous,'" and "catarrhal" 
fevers. These are merely complications of some of the forms of fever 
already described, with prominent symptom? of indigestion, or an in- 
creased and excessive secretion, of a slimy or mucous matter, from 
acrid bile or some other irritant, or the usual evidences of what is 
called a " cold in the head." Sometimes these local irritations are 
attended with such a degree of constitutional febrile disturbance as to 
receive the above appellations. 

Plague — Typhus Pestis. — The plague was first known in English 
history in 430, and lastly in 1679. In 302 it raged over Syria. In 
540, and for half a century afterward, it prevailed extensively over 
Europe and Asia. Since 1645, when it last visited Edinburgh, it has 
repeatedly ravaged all the continent of Europe. Marseilles was ravaged 
by it in 1720, and in the course of the seventeen preceding centuries, 
it experienced twenty-seven visitations. It prevailed at Moscow in 
1771 and 1772; at Noja, in 1815 and 1816; jn the lazaretto of Venice 
in 1818; at Malta, in 1813; and at Gressemberg, in Silesia, in 1819. 
Lately it lias been confined to the northern parts of Africa, where it is 
reputed to have originated. 

The history of the plague, like that of the cholera, is a tremendous 
lesson, whose true moral is hygiene, unfortunately, however, but little 
understood, and still less heeded. Wherever and whenever it has 
raged, the place and the people were buried, as it were, in their own 
filthiness, and rioting in the grossest sensuality. The narrow streets, 
dirty houses, unventilated apartments, and gross food of the inhabitants, 
with drunkenness and debauchery, have ever been the inviting causes 
of this pestilence in all the cities of the Old World where it has ravaged 
and desolated. Athens, Rome, London, which were formerly more 
than at, present, the world's great centers of luxury and licentiousness, 
have been repeatedly scourged with this prince of pestilences. Since 
the habits of the civilized world have become more cleanly, yet more 
debilitating, we have internal dyspepsias instead of external carbuncles, 
and the cholera instead of the plague. 

The character of the plague is that of a malignant exanthem ; n 
typhus fever of the putrid form, attended with carbuncular and imper- 
fectly suppurating tumors, sometimes running into deep gangrenous 
ulcere, the patient often feeling as if burning up with internal fire. 
The treatment, on hydropathic principles shoujd be the same as for 
the putpid form of typhus fever. 
? 



108 PATHOLOGY AND THERAPEUTICS. 



CHAPTER II. 

VISCERAL INFLAMMATION. 

In this chapter, I purpose to treat only of acute inflammatory affec- 
tions of the viscera. They are all characterized by a fixed pain or 
soreness, and sense of heat in the organ diseased, with a change in its 
secretory or functional action, and attended by a constitutional febrile 
disturbance. The accompanying fever may be either of the inflam- 
matory or typhoid type. A visceral inflammation may be defined a 
general fever with a disproportionate local affection. This class of dis- 
eases is almost universally treated by allopathic physicians on the anti- 
phlogistic plan — bleeding, salts, antimony, and a reducing regimen. 

The group of diseases naturally associated under this head comprises 
the following species : 

1. Inflammation of the Brain Phrenitis, 

2. " • Pharynx Quinsy. 

3. " Larynx Laryngitis. 

4. " Trachea Croup. 

5. " Parotid gland . .Mumps. 

6. " Lungs , Pneumonia. 

7- " Heart Carditis. 

8. " Stomach Gastritis. 

9- " Bowels Enteritis. 

10. " Peritoneum ...Peritonitis. 

1 1 • " Liver Hepatitis. 

12- " Spleen Splenitis. 

13. " Kidneys Nephitis. 

14. " Bladder Cystitis. 

15- " Uterus Hysteritis. 

1 6 - " Testes Orchitis. 

It is true that otitis (acute inflammation of the ear), ophthalmitis 
(acute inflammation of the eye), and dysentery (an acute inflammation 
of the mucous membrane of the bowels), belong pathologically to this 
group; but each possesses so many peculiarities, that system may be 
advantageously sacrificed to convenience ; hence they will be treated 
of in subsequent chapters. 

Theory of Inflammation. — Next tc fever the subject of inflam- 



VISCERAL INFLAMMATION. 109 

mation has occupied the attention and exercised the ingenuity of med- 
ical scholars. But still we have no satisfactory explanation of the 
proximate cause of its various phenomena. Two theories are, at the 
present time, about equally prevalent in medical schools, one of which 
is, singularly enough, the exact opposite of the other. But, stranger 
still, some of our popular medical authors who are diametrically opposed 
to each other in theory agree exactly in practice ; while others who 
agree exactly in theory are diametrically opposed in practice. These 
facts alone are sufficient to prove the whole pretended science of the 
popular system a mere hypothesis, and the whole drug-practice a mere 
experiment. 

To illustrate : one theory of inflammation is, that it consists essen- 
tially in an increased action of the capillary vessels of that part which 
is the seat of it ; and the other is, that it consists in a diminished ac- 
tion of the same vessels. Now, it would seem that these theories are 
distinctive enough to authorize opposite plans of treatment. But it 
does not so happen. Medical reasoning is a process sui generis. The 
most contradictory conclusions are often drawn from the same prem- 
ises, and the same conclusion is often deduced from the most opposite 
premises. All medical books extant of the allopathic school " agree to 
disagree" in this. They all recommend both stimulating and reducing 
treatment for all forms of inflammation, whichever theory they adopt. 
If a person has inflammation of the head, lungs, liver, joints, etc., with 
a full, strong, hard pulse, they say, " bleed, because it reduces the 
strength of the system, and abates the force of arterial action." If an- 
other has inflammation of the same parts, with a weak, frequent, op- 
pressed pulse, they still say, " bleed, because it strengthens the vessels 
by taking off a part of the load they have to carry."' So, whether the 
action is high or low, strong or weak, bleeding is the remedy. The 
theory and the practice have really nothing to do with each other on 
the depleting plan. Nor is there a better connection between theory 
and practice on the stimulating plan. In many forms of gout and 
rheumatism, in dysenteric inflammation, in burns and scalds, etc., stim- 
ulants are recommended by many authors, as cayenne, opium, oil tur- 
pentine, camphor, brandy, nitrate of silyer, spirits of nitre, mustard, 
etc. Why? "Because," say the theorists on the side of increased 
action, " the action of the capillaries has been preternaturally aug- 
mented, and we must let the action down gradually, by applying stim- 
ulants of a less intensity than the proximate causes of the diseased 
action ;" and on the other hand, the theorists on the side of decreased 
action say, " give stimulants, because the action of the capillaries has 
\>een prefer aaturally diminished, and thus excite them to greater ac- 
10 



110 PATHOLOGY AND THERAPEUTICS. 

tion." Such is the confusion in which the whole subject of inflnmma 
tion is involved — a confusion which, to my mind, is conclusive that both 
. theories, and all the practices predicated upon them, are radically 
erroneous. 

Rationale of Inflammation. — Experiments have amply demon- 
strated the fact, that the vessels in an inflamed part are distended with 
blood beyond their normal condition, anJ that the blood in them moves 
slower than in health. As far, then, as increased or diminished action 
is concerned, the latter theory seems plausible ; and all the conflicting 
methods of medication appear to aim at producing, directly or indi- 
rectly, one single effect, viz., contraction of the coats of the over-dis- 
tended vessels. For this purpose the most opposite agents and pro- 
cesses are resorted to ; the blood taken out, or brandy administered, 
hot fomentations employed or ice applied, refrigerating nitre or scorch- 
ing capsicum exhibited. 

There is, undoubtedly, in the early stage of inflammation, an in- 
creased contractile effort of the capillaries, but accumulation and en- 
gorgement with relaxation soon become their permanent condition. 
This temporarily increased action cannot, therefore, be regarded as 
the proximate cause of inflammation, but as the effort of nature to 
overcome its cause or counteract the effects. 

Inflammation, as well as fever, is the effort of the vital powers to 
protect the organism from injurious mechanical, chemical, or vital ir- 
ritants, or to expel morbific materials. This is proved by the phenom- 
ena of a multitude of morbid conditions. When a part of the body 
becomes gangrenous or dead, the living parts, provided there is suffi- 
cient vitality remaining in them, immediately form a line of demarka- 
tion, and the dead portion is soon separated from the living ; this pro- 
cess is called sloughing. When a chemical or mechanical body is 
imbedded in the flesh too firmly to be removed by absorption, as a bul- 
let or a splinter, purulent matter is 'brmed around it, and its further 
action on the parts is partially or wholly prevented by inclosing it in an 
abscess. When a grain of calomel gets into the lacteal vessels, the 
mesenteric glands, which may be regarded as organic inspection offices, 
receive an increased determination of blood, swell up, or inflame, and 
thus retard the contraband article, until it can be more or less modified 
or destroyed by the vital powers. When a structure is divided, as by 
an incised wound, coagulable lymph is poured into the wound, form- 
ing, as it were, a bed for the newly-formed vessels to re-unite the part 
— a process called adhesive inflammation. And when n portion of the 
flesh is torn away by violence, or decomposed by corrosives, or burned 



VISCERAL INFLAMMATION 111 



out, with fire, a covering of purulent mutter is thrown over the exposed 
surface, beneath which granulations — a new growth of substance — 
gradually fill up the cavity ; this process is called in medical books 
healthful or restorative inflammation. 

Varieties of Inflammation. — Various circumstances conspire to 
modify inflammatory affections so much as to allow of their division 
into several well-marked and distinctive kinds. Peculiarity of consti- 
tution, the structure of the part or organ, the nature and violence of 
the predisposing and exciting causes, are the most prominent of these 
circumstances. Inflammation tending to suppuration in a defined 
limit, as in the case of boils, abscesses, etc., is called phlegmonous. 
That form which is attended with eruptions, efflorescences, rashes, 
extensive ulcerations, rapidly-spreading gangrene, etc., is called ery- 
sipelatous, or erythematous. When it tends to the formation of a pre- 
ternatural membrane over th* mucous surface, as in croup, tubular 
diarrhea, catarrh of the bladder, catarrh of the uterus, etc., it is called 
membranous, or membranific. When it affects mainly the glandular 
structures and mucous or sen 'is membranes, without febrile symp- 
toms in the early stages, as in tubercular consumption, internal dropsy of 
the head, and swellings of the conglobate glands, it is called strumous, 
or scrofulous. When confined mostly to the structures of the joints, 
as in gout and rheumatism, it is called arthritic. 

Inflammation is also divided into acute, subacute, and chronic. The 
first is attended with general fever ; the second is accompanied with 
occasional febrile paroxysms ; the last is without constitutional febrile 
disturbance. 

Terminations of Inflammation. — All inflammatory affections ter- 
minate either in resolution — a gradual subsidence of all the symptoms ; 
or in gangrene— the death of the inflamed part. But there are many 
results or consequences of inflammation which are usually called 
terminations by medical authors. These are exudation or effusion, 
suppuration, ulceration, induration, and adhesion. 

General Treatment of Inflammation.— The hydropathic man- 
agement of a visceral or local inflammation is precisely the same as 
that of a general fever, with the addition of the local appliances. The 
heat, pain, swelling, and all incidental accompaniments, are to be treat- 
ed exactly as we would treat the same symptoms when present as 
complications of a simple fever. The regimen is also, in aU respects, 
the same as for simple fevers. 



112 PATHOLOGY AND THERAPEUTICS. 

Inflammation of the Brain — Piirenitis — Brain Fever. — This 
disease is also sometimes called phrensy. Some authors distinguish it 
into two forms — encephalites, when it affects principally the substance 
of the brain ; and meningitis, when it affects principally its investing 
membranes ; but as the disease, whichever structure is primarily af- 
fected, soon involves both, and as the treatment is in all respects the 
same, according to the vbVence of the symptoms, this distinction has 
no practical utility. 

Symptoms. — Acute or excruciating pain in the head, throbbing of 
the temporal and carotid arteries, flushed face, eyes injected and bril- 
liantly reddish, contracted pupil, and a wild expression of countenance, 
characterize the disease when fully formed. These symptoms are 
preceded by various cerebral and febrile disturbances, sometimes vio- 
lent delirium, at other times nausea and vomiting, or general con- 
vulsions. The bowels are usually extremely costive. There is also 
great intolerance of light and sound, incessant watchfulness, the skin is 
dry and hot, the pulse hard and quick, the tongue is dry and covered 
with a white fur, and there is intense thirst. 

Special Causes. — Exposing the head to a hot vertical sun, violent 
exercise, intense study, excessive passion, external violence, metastatic 
gout or rheumatism, and repelled eruptions, are among the most fre- 
quent of the exciting causes. 

Diagnosis. — Inflammation of the brain resembles, in many promi- 
nent symptoms, several other complaints, from which it is indispensable 
to distinguish it. From mania, it is known by the accompanying fever; 
from the delirium of inflammatory fever, by the delirium in the latter 
case succeeding instead of preceding the febrile symptoms ; from the 
delirium of typhus, by the suddenness of its attack ; from the cerebral 
irritation or determination to the brain arising from the effects of loss 
of blood, by the pallor of the skin and countenance in the latter case ; 
and from delirium tremens, by the pallor of the surface and, geoEtral 
tremor of the body and limbs which denote the latter. 

Peculiarities of Treatment. — In most cases, inflammation of "the 
brain is attended with synochus, or high fever, and requires thorough 
general and local cold treatment. The immersion-bath is excellent; 
or the patient may be enveloped in double or treble wet sheets, while 
the head is cooled with pounded ice, cold cloths, or the pouring-bath. 
The extremities must be carefully watched, and if the feet are not hot, 
like the rest of the body, they should be bathed in warm water. The 
constipated state of the /vowels, of course, requires copious tepid injec- 
tions. In some cases where the whole scalp feels excessively sore and 
tender, cold water feels disagreea <le, and then tepid water is moro 



VISCERAL INFLAMMATION. 113 

soothing, and, by more rapid evaporation, will cool the head as effectu- 
ally as the cold water will in other cases. If a single sheet is employed 
for packing, it wil require to be renewed several times a day. 

Inflammation oj the Throat — Quinsy. — Under this head are 
included four distinct forms of inflammation of the throat, all of which 
are characterized by heat, redness, and swelling of the fauces, with 
painful and difficult deglutition. 

Symptoms. — The first form of the disease under consideration is the 
common quinsy, or lonsiUitis of authors, called also cynunche or angina 
in medical books. It consists of a swelling of the mucous membrane 
of the fauces and tonsils, by which the functions of swallowing, respira- 
tion, and speech are performed with great pain and difficulty; the ac- 
companying fever is violent, and the disease terminates in a few days 
by resolution or suppuration. The second form is known as the malig- 
nant, or ulcerated sore throat. The attending fever is typhoid; the 
fauces exhibit a crimson flush, with ulcerations covered with mucus, 
and spreading sloughs, of an ash or whitish hue. This form is fre- 
quently epidemic. In the third variety, the redness is more florid, 
and is most violent at the lower part of the fauces ; the swallowing is 
extremely painful and difficult. The fourth variety has been called 
quinsy of the asophagus ; the difficulty in swallowing i3 felt below the 
pharynx, and the food is generally rejected when it reaches the seat 
of obstruction. 

Special Causes. — All of these forms of throat disease are most com- 
mon in spring and fall, which fact shows that sudden changes of 
weather, or "taking cold," are their principal exciting causes. 

Peculiarities of Treatment. — The wet compress, consisting of several 
folds of linen wet in cold water, must be promptly applied around the 
throat, and frequently renewed. The whole body must be well rub- 
bed in the dripping sheet, or tepid half-bath, and then wrapped in the 
dry blanket, so as to produce moderate perspiration ; or the general 
fever may be treated with the wet-sheet pack. In the malignant form, 
small draughts of iced- water should be frequently taken, and the coldest 
water, or pounded ice, applied to the throat whenever the morbid heat 
is troublesome. 

Inflammation of the Larynx — Laryngitis. — This disease, in 
some of its symptoms, resembles quinsy, and in a still greater number, 
the croup. It consists in a suppurative inflammation of the membranes 
of the larynx, extending backward to the membrane common to itself 
and the (esophagus, be:\veen which purulent matter is often formed 



114 PATHOLOGY AND THERAPEUTICS. 

It is a disputed point whether Washington, in his last illness, was 
attacked with this disease or common quinsy; but it is certain that he 
died of antimony and the lancet! 

Symptoms. — After the ordinal / symptoms of fever, the voice be- 
comes hoarse and indistinct; the breathing laborious, with a painful 
sense of constriction in the throat; the fauces are swelled and turgid, 
the swelling extending to the face and eyes, the latter sometimes pro- 
truding as in cases of strangling; the pulse is frequent, the tongue 
furred, and every attempt to swallow is attended with great distress, 
the muscles of deglutition being thrown into violent spasms, threatening 
the patient with instant death from suffocation. 

Diagnosis. — It is distinguished from croup by the existence of a con- 
stant and voluntary hawking, rather than a forcible and involuntary 
cough ; and from common quinsy by the absence of any considerable 
swelling of the tonsils. 

Peculiarities of Treatment. — There is no material difference in the 
therapeutic management required for this and the preceding malady, 
except that indicated by the danger of immediate suffocation. Ice- 
water gargles should be freely employed, in conjunction with cold wet 
cloths to the throat, and the general tepid-bath, or wet sheet; and if 
the extreme sense of suffocation is not relieved in a few hours, the 
patient should be put into a full hot-bath for ten or fifteen minutes : if, 
however, this is impracticable, the hot fomentations to the abdomen 
should be resorted to occasionally, in connection with the general and 
local treatment already mentioned. 

Inflammation of the Trachea — Tracheitis — Cyivanche 
Trachealis — Bronchlemmitis — The Croup. — This disease con- 
sists of a peculiar inflammation of the mucous membrane of the 
trachea, or windpipe, attended with a thick, tenacious, glairy secretion, 
which hardens, if the disease is not soon arrested, into a preternatural 
membrane, and produces death by closing up the air-passage in the 
larynx. In some few instances, however, it has been expectorated. A 
similar membrane is also sometimes formed in the bowels, bladder, or 
uterus, and cast off in the form of a tube, or of fragments resembling, 
and sometimes mistaken for portions of the mucous membrane. 

Symptoms. — The, first stage is denoted by a ringing cough, to which 
many children are subject on taking cold, attended with little or no 
change in the breathing or voice. This may be tailed the premonitory 
ot.ige. In the second stage there is a shrill, ringing cough, with ditfi- 
sult bieathing; the voice is altered, hoarse, and broken; the breathing 
is sometimes hUs g, and a other times creaking or crowing; the eyes 



VISCERAL INFLAMMATION. 115 

are heavy, watery, and bloodshot, and many patients die before the 
disease progresses further. In the third stage the cough and voice 
are stridulous, the respiration is laborious and suffocative, and the case 
is generally regarded as hopeless. The cheeks, eyes, and nails mani- 
fest a purple redness; the complexion is often mottled, or the flush of 
the cheek is circumscribed ; the pulse is very small and frequent. In 
the fourth stage the voice is whispering and low; the cough less fre- 
quent, and scarcely audible across the room ; the trachea is coated with 
effusion ; the face is leaden, the eye filmy, and the extremities cold, 
and final insensibility is gradually closing the scene. 

Special Causes. — The croup most frequently attacks children be- 
tween the ages of one year and twelve, though occasionally it occurs 
in infants at the breast; and very rarely in adults. Sudden alternations 
of temperature, especially going from a heated, ill-ventilated apartment 
to a humid atmosphere, or vice versa, with little or no attention to bath- 
ing habits, are among the prominent circumstances which co-operate 
to produce this disease. 

Peculiarities of T reatment. — As the danger from this disease consists 
in the effusion which concretes into the artificial membrane, the treat- 
ment should contemplate the arresting of this secretion at the earliest 
possible moment. The whole throsit must be instantly enveloped in 
several folds of very cold wet cloths, and these should be very frequent- 
ly changed until the respiration becomes free. If the fever is not very 
high, the whole body should be bathed in tepid water at about 70°, and 
then packed in the dry blanket, until the heat returns, or perspiration 
takes place. If the general fever and heat of the surface are consider- 
able, the wet-sheet pack is the best, to be renewed occasionally, and 
managed in all respects as for a common fever. Attention to the bow- 
els, cold extremities, irregular temperature, etc., is required, as in all 
febrile and inflammatory complaints. 

When called to a patient, after the partial or complete consolidation 
of the tenacious secretion, evinced by extremely painful and suffocative 
breathing, and constant, but unavailing efforts to expectorate, warm' 
water should be copiously drank, and the throat tickled with the finger 
or a feather, so as to provoke moderate vomiting. Nearly every case 
of croup can be cured by a prompt recourse to these measures on the 
first attack. But all treatment may fail in the third and fourth stages 
of the disease. The preternatural membrane has, in a few instances, 
been expectorated in fragments, and the patient recovered; but usually 
its formation is fatal. 

Inflammation ok the Parotid Gland — Parotitis — Mumps.- 



116 PATHOLOGY AND THERAPEUTICS. 



The mumps consist of a painful, unsuppurative swelling of one or both 
parotid glands ; it is contagious, and often epidemic ; it is often accom- 
panied with swelling of the testes in males, and of the breasts in females. 

Symptoms. — The tumor is at first movable, but soon becomes diffused 
to a considerable extent ; it increases till the fourth day, and often in- 
volves the maxillary glands in the inflammation. It is attended with 
but slight febrile disturbance, and gradually declines after the fourth 
day. 

Peculiarities of Treatment. — Very little medication is required in 
ordinary cases. Abstemious diet, the wet sheet whenever the whole 
surface is affected with feverish heat, and the application of a wet linen 
cloth, covered with a dry one, to the inflamed part, whenever this is 
very hot or painful, constitute the remedial plan. Whenever metastasis 
occurs to the testes or breasts, the full warm-bath should be employed, 
succeeded by wet compresses to the part affected, well covered, so as 
to produce the fomentation or poultice effect. 

Inflammation of the Lungs — Pneumonia — Pneumonitis—- 
Peripneumont — Lung Fever — Pleurisy. — All of these terms have 
been employed to designate the same essential disease, which is an 
acute inflammatory condition of some part or all of the substance of the 
lungs, or of their surrounding membranes, or of both. Medical authors 
apply the term pleurisy to the disease when it primarily attacks the 
pleura; and the term pneumonia, or pneumonitis, when the primary 
attack appears to be in the parenchyma, or substance of either or both 
lungs. The term peripneumonia notha, or bastard pneumonia, has beeu 
given to a modification of the disease, attended with a low, typhoid 
fever of the nervous type, which has sometimes prevailed as an epi- 
demic. Practically, all these distinctions are useless; for whether the 
inflammation first affects the investing membranes or the substance of 
the lungs, it soon involves both ; and precisely the samo treatment is 
indicated whether wo call it one or the other of these technical 
names. 

Symptoms. — Sometimes the constitutional symptoms appear first, as 
rigors, flushed, purplish face, injected appearance of the eyes, furred 
tongue, etc., and sometimes the local symptoms precede ; these are 
great heat and sense of weight about the chest ; dull, deep-seated, or 
acute pain ; short and dry cough, with a slight mucous expectoration ; 
frequent, short, and anxious respiration. In a day or two the expecto- 
ration becomes viscid, and more or less rusty-colored, yellow, or bloody. 
The pulse is full, strong, and quick, or small, weak, and frequent, as 
the fever approximates the inflammatory or typhoid type. Dr. Shew, 



VISCERAL INFLAMMATION. 117 

in his Manual, mentions "no pulse" as among the symptoms, out this is 
most assuredly a mistake. 

Terminations. — This disease terminates by resolution, suppuration, 
gangrene, effusion, or hemorrhage. Under thorough water-treatment 
from the outset, it has always, within the scope of my experience and 
observation, terminated very promptly by resolution. 

Special Causes. — Extreme vicissitudes of temperature, unequal ex- 
posure of the body, cold or wet feet, exposure to wet or cold when 
the body is in a state of exhaustion from sleeplessness or over-exertion, 
are especially conducive to this disease. 

Peculiarities of Treatment. — If the general febrile symptoms pre- 
cede the local, the wet sheet is to be resorted to, and repeated accord- 
ing to the degree of superficial heat. When the local pain, cough, 
difficulty of breathing, etc., appear, the chest-wrapper should be con- 
stantly worn, covered with a dry cloth, and renewed five or six times 
a day. The shallow tepid-bath, or if this is impracticable, the tepid 
sitz-bath, should be employed onco or twice in twenty-four hours. 
When the heat is uuequally developed, the pulse low, the patient ex- 
tremely prostrated, and the extremities pale or cold, the warm sitz and 
foot-bath are serviceable. Free tepid injections are generally advisable; 
and when the expectoration is painfully sticky and scanty, warm water- 
drinking, to the point of slight nausea, or even moderate vomiting, will 
afford speedy relief. 

Inflammation of the Heart— Carditis.— Whether the mus- 
cular substance of the heart is ever the seat of an inflammatory affec- 
tion which is capable of distinct recognition, is a disputed point. But 
inflammation of its investing membranes, though a rare disease, is re- 
cognized in all standard works ; as pericarditis — inflammation of the 
heart-purse, or pericardium; endocarditis — inflammation of the inter- 
nal membrane which lines the cavities of the heart. For all practical 
purposes, they may all be considered as simply inflammation of the 
heart. 

Symptoms.— With general febrile disturbance there is more or less 
acute pain under the left nipple, toward the lower extremity of the 
breast-bone ; this pain radiates toward the left armpit, and sometimes 
extends downward to the elbow or wrist; the pain is increased by 
pressing upward against the diaphragm, and by lying on either side. 
The pulse may be full, hard, regular, and jarring, or small, rapid, un- 
equal, and intermitting; there is great difficulty of breathing, an insup 
portable sense of oppression, frequent sweats, often alternated with 
very dry and hot skin. The countenance is pa_e, sharp, and marked 



118 PATHOLOGY AND THERAPEUTICS. 



with great anxiety and terror; sighing, sobbing, and hiccc igh are fre- 
quent, and sometimes delirium, convulsions, or insomnolence attend. 

Special Causes.— Among the predisposing causes of this affection 
Hooper mentions, " the male sex, and the age from ten to thirty." If 
he had said that males between the ages of ten and thirty are most 
subject to the disease, his talk would have beeu rational; but to put 
down such circumstances as causes is flat nonsense. The most com- 
mon cause of heart diseases is the allopathic treatment, alias mal- 
treatment of gout and rheumatism, which produces a metastasis of 
arthritic inflammation from the membranes of the joints to those of 
the heart. 

Peculiarities of Treatment. — The hydropathic management is pre- 
cisely the same as for inflammation of the lungs. 

Inflammation of the Liver — Hepatitis. — Acute inflammation 
>f the liver is, in this climate, a rare disease ; but is rather frequent in 
hot countries, especially with those who indulge freely in flesh-eating 
and spirit-drinking. 

Symptoms. — Pain in the right side under the short ribs, increased 
by a full inspiration, or by lying on the left side ; dry, husky cough, 
shortness of breath, shooting pains about the chest, sympathetic pain 
in the right shoulder, yellow appearance of the white of the eye, and 
sometimes yellow skin; the urine is high-colored, and there is either 
costiveness or diarrhea. 

Chronic inflammation of the liver — hepatitis chronica of the books — 
often manifests some degree of most of the symptoms above-mention- 
ed, but is distinguished by the absence of general fever. 

Peculiarities of Treatment. — Apply the wet girdle around the upper 
part of the abdomen, over the seat of the principal pain ; in all other 
respects manage as in the case of inflamed lungs. The bowels should 
be thoroughly cleansed in the outset with warm water enemaia. 

Inflammation of the Spleen — Splenitis. — This is an exceed- 
ingly rare disease. It is known by s'evere pain in the left side opposite 
the liver, with a sense of heat and weight, and considerable fullness 
and tenderness ; the pain is increased on pressure. The treatment is 
the same as for inflamed liver. 

Inflammation of the Stomach — Gastritis. — Dr. Good distin- 
guishes acute inflammation of the stomach into two forms, adhesive 
and erythematic. In the former variety the fever is high, s..« inflamma- 
tory ; in the latter, low, or typhoid. 



V I S C E K V L INFLAMMATION. 1 19 



Symptoms. — With general fever there is severe fixed pain and burn- 
ing heat at the pit of the stomach ; painful deglutition ; the pain is in- 
creased by pressure over the stomach ; frequent vomiting, hiccough, 
sudden and extreme prostration; hard, wiry, rapid, and often irregular 
nnd intermitting pulse ; intense thirst ; restlessness and anxiety ; tongue 
red, parched, and of a gla/.ed appearance. Frequently the inflamma- 
tion extends to the bowels, attended with diarrhea and great tenderness 
of the abdomen, constituting the gas' r o-enteritis of authors. 

Special Cause;;. — In a majority of cases gastritis is the effect of pow- 
erful irritants or chemical poisons taken into the stomach. It is some- 
times produced by drinking largely of ve?y cold water when the body 
is excessively heated by exercise, especially in persons whose stomachs 
are enervated by spirituous liquors. Unripe fruits, decayed vegetables, 
and putrid animal food, sometimes excite it. 

Peculiarities of Treatment. — Apply wet cloths freely to the whole 
abdomen, of the temperature which feels most agreeable and soothing 
to the patient. Generally quite cold water answers the best. Small 
quantities of ice or iced-water may be frequently taken. Drink ad 
libitum of water of a moderate temperature — 60° to 70"\ Tepid in- 
jections are generally necessary ; when diarrhea attends they may be 
used cold. The entire wet sheet envelopment should be employed 
two or three times a day when the febrile heat is general and excessive. 

Inflammation of the Bowels — Enteritis. — This disease, like 
gastritis, is divided into the adhesive and ery thematic varieties, by Dr. 
Good. The former variety is attended with obstinate constipaciou ; the 
latter with diarrhea. 

Symptoms. — With more or less of general fever there is acute pain 
in some part of the abdomen, gradually extending over the whole; the 
.pain is increased by pressure, and accompanied with tension and swell- 
ing. The patient lies on the back with the knees drawn up, and can 
scarcely" suffer the weight of the bed-clothes. The bowels are usually 
obstinately constipated, but sometimes diarrhea attends; and there is 
constant nausea, ard more or less vomiting of bilious and sometimes of 
highly offensive fcecal matter. The pulse js frequent, hard, and con- 
tracted. 

Special Causes. — Long-retained and hardened feces; constipating 
food; irritant poisons ; impure aliments. 

Diagnosis. — Enteritis is distinguished from colic by the presence of 
fever. In colic the pain is diminished by pressure. 

Peculiarities of Treatment. — The constipated state of the bowels 
requires the free employment of copious tepid injections ; in all other 



120 PATHOLOGY AND THERAPEUTICS. 



respects the treatment is the same as fur gastritis. It is not advisable, 
however, to resort to' the injections until the heat and tenderness of the 
abdomen has been somewhat reduced by the external applications. 
When severe diarrhea occurs, the warm sitz-bath and cool injections 
may be occasionally employed to advantage. 

Inflammation of the Peritoneum — Peritonitis. — Authors dis- 
tinguish three varieties of acute peritoneal inflammation : peritonitis 
proper, when the lining serous membrane of the abdomen is generally 
affected; omentalis, when the omentum is the principal seat of dis- 
ease ; and mesenterica, when the inflammation affects principally that 
portion called the mesentery. 

Symptoms. — The usual accessory symptoms of general fever are 
succeeded by a sense of heat and pain in the abdomen, usually confined 
to one part, but gradually becoming diffused. There is great tender- 
ness or soreness of the. belly, without inclination to go to stool, and a 
considerable degree of tension and swelling comes on, which ordinarily 
increases for several days ; the patient finding most relief when lying 
motionless on the back, with the knees somewhat elevated. The 
tongue is not much altered at first ; the pulse is small, weak, and very 
frequent. This disease frequently attends as a symptom of puerperal 
fever, which fever is generally the result of bad management during 
the period of childbirth. 

Diagnosis. — It is distinguished from colic by the pain being increased 
on pressure, and frequency of the pulse. It is not so easily distinguish- 
ed from enteritis ; but this is of no consequence, as the treatment is in 
all respects precisely the same. 

Inflammation of the Kidney — Nephritis, — Symptoms. — Gene- 
ral fever, pain in the region of the, kidney, extending to the groin and 
along the ureter to the neck of the bladder. The pain is deep-seated, 
often dull and obscure, but always increased by the erect posture, by 
coughing or sneezing, or by firm pressure. It is also increased by 
straightening the leg of the affected side. To avoid this the patient 
instinctively reclines on the affected side, and bends the limb so as to 
relax the muscles of the groin. There is frequent desire to urinate, 
with great difficulty or inability to expel the contents of the bladder. 
The urine is generally bloody at first. The tongue is white, the pulse 
is hard and frequent, the bowels are constipated, the abdomen is tym- 
panitic, with wandering pains, and the patient labors under great de- 
pression of spirits. 

Special Causes. — Acrid diuretics, hard water, gravel, violent exor 
cise of the muscles of the back, hardened fceces in the colon. 



VISCERAL INFLAMMATION 121 

Diagnosis. — It may be distinguished from lumbago by the pain 
following the course of the ureter, and by the difficulty of urination. 

Peculiarities of Treatment. — If the fever is not violent, and the 
heat of the surface is irregular, the warm hip-bath will alleviate the 
pain. If the heat of the surface is great and uniform, the cold hip- 
bath will produce the greatest relief. One or the other should be fre>- 
^uently employed, with general and topical treatment, as in other 
'isceral inflammations. 

Inflammation of the Bladder — Cystitis. — Idiopathic inflamma- 
tion of the bladder does not often occur. It does, however, sometimes 
result from the common causes of inflammation, but is more frequently 
the consequence of gravel, stone, long retention of urine, maltreated 
gonorrhea, and such drug-irritants as cantharides, ardent spirits, tur- 
pentine, and various essences and balsams. 

Symptoms. — General fever; acute pain, swelling, and tension in the 
region of the bladder ; pain and soreness increased by pressure above 
the pubes, or in the perineum ; vomiting ; tenesmus ; frequent mic- 
turition, with great difficulty in discharging the urine ; heat and smart 
ing in the urethra; great general irritation, l-estlessness, and anxiety. 

Peculiarities of Treatment. — On account of the structure of the 
urethral passage, the warm hip-bath should be at first employed for 
half an hour, or until sensible relief is experienced. This should be 
succeeded by the cold compress, which should be worn constantly and 
very frequently renewed, occasionally alternating with the warm hip- 
bath. The febrile symptoms are to be treated with the wet-sheet 
pack, followed by the dripping sheet or tepid half bath, as often and 
whenever they are indicated by the general heat. The vomiting may 
be relieved by warm water-drinking, followed by sips of cold water or 
bits of ice. The tenesmus requires copious injections of warm water, 
followed, after the bowels have acted freely, by the injection of as 
much cold water as the bowels can conveniently receive. The warm 
foot-bath is useful when there is the least tendency to cold extremities. 

Inflammation of the Uterus — Htsteritis — Metritis.— This 
disease has been divided into two varieties — simple, when occurring in 
the unimpregnated organ; and puerperal, when attacking the womb 
soon after delivery. 

Symptoms. — Nearly every symptom characterizing inflammation of 
the bladder Attends also inflammation of the uterus ; in the disease un- 
der consideration there are the additional symptoms of pain extending 
with great severity to the loins, and shooting down the thighs, and aa 
11—11 



122 PATHOLOGY ANE THERAPEUTICS. 



increase of pain in the hypogastric region on the patient's making a 
deep inspiration. There is also a sense of weight and bearing down, 
with a frequent, small, and wiry pulse. 

Speciul Causes. — Suppressed menstruation, extraordinary mental 
emotion, astringent or irritating injections. 

Peculiarities of Treatment. — The treatment for the preceding dis- 
ease is equally applicable to this. 

Inflammation of the Testes — Orchitis. — This affection is read- 
ily known by the pain, heat, redness, and swelling of the part affected; 
it is attended with more or less general fever. It only requires the 
constant application of water, either by compresses or the hip-Lath, of 
such temperature as is most soothing to the pain ; and the wet-sheet 
pack or tepid full-bath, according to the degree of general heat. 



CHAPTER III. 

arthritis;. 

Arthritic inflammation comprehends the various forms of gout, and 
rheumatism. The peculiarity of this kind of inflammation consists in 
its being confined mainly to the fibrous tissues — the muscles, and struc- 
tures around the joints. Its character is also erratic, often shifting its 
6eat of morbid action from slight causes. The diseases included under 
the present head may be grouped as in the following arrangement: 



A: 



egular, 



I Atonic, 

1 Recedent, Rheumatism. \ 

Misplaced. 



Inflammatory, 

Articular, 

Lumbago, 

Sciatica, 

Muscular, 

Chronic. 



Gout— Podagra.— Dr. Good tells is (Study of Medicine) "that 
the predisposing cause of a gouty diathesis, when '.t first forms itself in 
an individual, is plethora, or the state of the system produced by full 
living and indolence." Strangely inconsistent with this remark the 
same author observes: "There is no disease to which the human 
frame is subject that has le'2 to such a variety of opinions both in the- 



ARTHRITIS. 123 



ory and practice, many of them directly contradictory to each other, as 
the gout; and I may add, there is no disease concerning the nature 
and treatment of which physicians are so little agreed." Nothing can 
be more conclusive of the absurdity of the whole philosophy of the 
popular system, and the empiricism of its whole practice* than this 
general agreement about the producing cause of a disease, and this 
general disagreement about its nature and treatment! 

Symptoms. — Regular gout is characterized by a violent inflamma- 
tion and swelling of the joints, enduring for several days, and grad- 
ually subsiding with itching and desquamation of the cuticle. It usually 
comes on an hour or two after midnight, with excruciating pain in the 
joints of the great toe, which grows worse as the day advances, grad- 
ually ceasing toward evening, to return with more or less violence the 
next morning ; and so on for several days. The attack is preceded by 
various symptoms of digestive derangement, and wilh coldness, numb- 
ness, and cramps of the extremities. The atonic or disguised form is 
attended with greater general debility and worse dyspeptic symptoms, 
while the affection of the joints is but, slightly painful and inflammatory. 
The local affection often alternates with the symptoms of indigestion, 
when pain in the stomach, nausea, vomiting, eructations, etc., occur, 
and the patient is dejected and hypochondriac. Cramps in the trunk 
and extremities are common, and there may be either obstinate cos- 
tiveness or diarrhea. Sometimes the affection of the joints alternates 
with a disturbance of the viscera of the chest, producing palpitation, 
syncope, or asthma; at other times with the head, which <s affected 
with vertigo, cephalalgia, and sometimes even with palsy or apoplexy. 
The recedent or retrograde form is marked by a sudden subsidence of 
the inflammatory state of the joints, succeeded immediately by an ■■ 
fection of some internal part, where is thenceforth the seat of the 
morbid manifestations. The head, heart, or lungs may be affected, 
producing the results named in the preceding remark. The mis- 
placed variety is denoted by an inflammatory affection of gome inter- 
nal part or organ in a gouty diathesis, whether preceded or not by an 
inflammatory affection of the smaller joints, which, however, always 
very soon disappears. 

Diagnosis. — Gout may be distinguished from rheumatism by its 
commencement in the small instead of the large joints; also by the 
peculiar manner of attack. When the gouty diathesis is strongly mark- 
ed, the joints of the toes, and sometimes those of the fingers, are per- 
manently enlarged and disfigured. 

Causes. — The gout is emphatically the disease of the gourmand and 
the epicure. Wherever this diathesis prevails, there has nature 



124 Pi.TnOLOGF AND THERAPEUTICS. 



stamped, in painfully legible characters, the penalty of riotous living. 
A vegetable-eater and water-drinker has never, probably, been afflicted 
with any "joint-racking rheums" like unto this malady, since the cre- 
ation, unless inherited. It is said, indeed, not to be exclusively confined 
to " high life," as it is occasionally known among the poor and laboring 
classes. No doubt the indigent and hard-working can eat and drink iu 
such a way as to produce it. Yet we know this is very uncommon ; 
and we must regard the disease as, in a general sense, the legitimate 
fruit of fashionable yet unnatural luxury. Flesh and wine represent 
the nature of its predisposing causes. The free indulgence in animal 
food of any sort, and the free use of fermented liquors of any kind, 
are among its prominent causes ; and when to these are added con- 
centrated and constipating fo^d, with sedentary or indolent habits, we 
have ihe general condition which produces the gouty diathesis in its 
greatest intensity. The diathesis sometimes exists in those who eat 
iatemperately and drink temperately, or vice versa. 

In gouty subjects, the functions of alimentation so frequently overact 
those of elimination, that the surplus materials obstruct the capillaries, 
and the retained morbific matters so change the secernent action, that 
chalky concretions are formed in and around the cavities of the joints, 
in the ligaments, tendons, and membranes, in the little mucous bags — 
bursa mucosa — which surround the joints, in the cellular substance, 
and even in the pores of the skin. The joints of the fingers and toes, 
more especially the latter, are frequently enlarged, hard, and tender, 
occasionally ulcerate, and sometimes form fistulous openings, through 
which oozes a whitish earthy matter, consisting mainly of urate of soda. 

Treatment. — The indications are : 1. To relieve the paroxysm. 2. 
To prevent its return. These mean, in other words, to mitigate the 
pain, and restore general health. Cold or very cold wet cloths should 
be constantly applied to the affected parts until the pain subsides ; or 
the feet or hands, when inflamed, may be held in cold water until the 
preternatural heat is subdued. There is no danger whatever of pro- 
ducing metastases to the internal organs — as bleeding, blistering, drastic 
purging, etc., do produce— by the application of cold water to the in- 
flamed joints, provided the application is not continued beyond the 
point of reducing the temperature to the natural standard. The gen- 
eral feverishness attending the parox3 7 sm requires the wet-sheet pack, 
so managed as to produce moderate perspiration, followed by the shal- 
low tepid-bath. Water-drinking should be as copious as the stomach 
can bear without painful distension, and the diet should be of the 
"hunger-cure" kind. 

To overcome the gouty diathesis requires a systematic employment 



ARTHRITIS. 125 



of the water processes, with the strictest general regimen. A daily 
pack for au hour, followed by a plunge, dripping sheet, or half-bath, a 
daily tepid shallow-bath for ten minutes, with the pail douche over the 
shoulders, a daily hip-bath at about G5° for fifteen minutes, a daily 
foot-bath at about the same temperature for ten minutes, constitute the 
average number and strength of the bathing part of the regular treat- 
ment. In addition to all this, the douche may be applied to the affected 
part with as much force as can be borne without much pain, and mod- 
erately along the spine, two or three times a week. With these pro- 
cesses the patient should exercise all that his strength will admit of, 
short of absolute exhaustion, and drink all the water the stomach can 
endure without pain. The diet must be plain and unconcentrated, 
consisting mainly of vegetables, ripe fruits, and unbolted farinaceous 
preparations. Nearly all medical authors agree that gouty subjects 
ought to be put upon an abstemious vegetable diet. Even many writers 
who insist that man is naturally omnivorous, and cannot subsist on an 
exclusively vegetable diet, seem to forget their darling theory, and 
prescribe for this disease what they specially interdict in almost every 
other. 

The bathing part of the treatment, may be managed in various ways, 
according to convenience, with equal efficacy. The following plan, 
with such modifications as circumstances will naturally suggest, is 
adapted to all ordinary cases: In summer, a plunge-bath on rising in 
the morning, followed by a long walk; at ten a.m., the pack and douche ; 
at four to five p.m., half-bath and pail douche; at half-past eight p.m., 
sitz-bath. A foot-bath may be taken at either nine a.m., five to six 
p.m., or evening, or at all of those times. In winter, a pack and half- 
bath in the morning,; douche at ten a.m.; half-bath at four to five p.m.; 
sitz in the evening; foot-baths as above. 

Gouty patients who have been drugged extensively, their nerves 
enfeebled and their constitutions shattered with opium, colchicum, 
veratrum, elaterium, antimony, etc., must be managed with more care 
and tenderness. They will not bear as cold nor as vigorous treatment. 
For such, the pack and dripping sheet, the tepid shallow-bath, and oc- 
casionally, when they become unusually tender and irritable, the full 
warm-bath, followed by the tepid pail-douche, are the best leading 
water appliances. 

Ciises in Gout. — While under treatment, gouty patients are liable 
to critical disturbances in the form of boils, diarrhea, and particularly 
to a general feverishness, during which all the affected parts, and 
sometimes the whole body, becomes highly and suddenly inflammatory 
and painful. The full warm-bath, or the moderately hot bath, is useful 



126 PATHOLOGY AND THERAPEUTICS. 

once or twice during the latter form of critical disturbance, which 
usually lasts several days. Diarrhea, if severe, requires the warm 
sitz-bath and cool injections; boils need nothing but wet compresses. 
Whenever the crisis is sev( re, all active treatment should be suspended ; 
wet cloths, or cold water in any convenient way, may, however, be 
applied to swelled and painful parts during the crisis the same as at 
other times. 

Rheumatism. — Like gout rheumatic affections are almost invariably 
connected with dei-angements of the digestive apparatus, and generally 
preceded by unusual disturbance in the functions of the primary nutri- 
tive organs. Some authors, indeed, maintain that gout and rheumatism 
are convertible maladies, often blending together, or running into each 
other, in their varied local manifestations. In fact, rheumatism might 
very well be defined as gout of the larger joints ; while the stiffness, 
lameness, and rigidity of the muscles, and the thickening and swelling 
of the structures in and around the joints, are about as common to 
either manifestation of the arthritic diathesis. 

Symptoms. — Inflammatory rheumatism presents all the essentia! 
symptoms of inflammatory fever, or synochus, with the addition of ex- 
treme soreness and tenderness over the whole surface of the body, and 
also acute pain in some one or more of the larger joints, or in the small 
of the back, rendering all motion of the body and limbs extremely diffi- 
cult and painful The patient is often unable to get on or off the bed 
without assistance, and then the effort is attended with great suffering. 
The articular variety has been called rheumatic fever, or acute rheu- 
matism. It differs from the former in being attended with much less 
general pain and soreness, and a much greater inflammatory action 
and swelling of some one or more of the large joints and surrounding 
muscles, generally the hip, knee, elbow, or shoulder. Lumbago is the 
variety in which the pain is felt chiefly in the loins, usually shooting 
upward. In the form called sciatica, or coxalgia, the pain is felt mostly 
in the hip-joint, the disease also being attended with an emaciation of 
the nates or buttock of the affected side, or an elongation of the limb. 
In the variety called muscular, the pain is experienced mainly in the 
muscles of the diaphragm, or in the intercostal muscles between the 
ribs, when the pain is greatly increased by a full inspiration. This 
form has been called pleurodyne, pleuralgia, and spurious pleurisy by 
authors; and not unfrequently mistaken for real pleurisy, and the patient 
bled, leeched, and blistered not a little to his disadvantage. Chronic 
rheumatism is characterized by pain, rigidity, and weakness of the 
larger joints and surrounding muscles, accompanied with no regular 



ARTHRITIS. 127 



fever, and but slight occasional febrile paroxysms, and with very little 
perceptible swelling. This form of rheumatism is almost always re- 
lieved temporarily by warmth, hot applications, stimulating liniments, 
etc., while all the other forms are frequently aggravated by them. 

The fever attending rheumatic attacks is peculiarly accompanied 
with frequent and irregular sweats, which, however, do not prove in 
any sense critical, nor exert any marked influence upon the course of 
the disease. 

Causes. — Unusual exposures to wet and cold while the body is in a 
state of exhaustion or obstruction, seem to be the general producing 
causes of all forms of rheumatic affections. 

Treatment.— 'The. proper management of the first, or inflammatory 
variety, is almost identical with that of inflammatory fever. In some 
cases where the joint or joints most affected are so tender that the 
lenst motiHn produces excruciating pain, a combination of relaxant and 
cooling processes will give prompt relief, as the warm fomentation, or 
warm douche, followed by the coldest wet cloths or pounded ice. The 
articular form requires a less vigorous application of the wet sheet, or 
other general cold treatment, but a more persevering application of cole" 
compresses to the affected joints. Lumbago and sciatica, and that form 
called muscular, in addition to moderate general treatment, are relieved 
with the greatest facility by the hot fomentation to the parts affected 
with pain, stiffness, and rigidity, followed by the cold covered compress, 
or, what is better still, the warm douche followed by the cold, the tem- 
perature and force of the stream to be regulated in some degree by 
the patient's feelings. Chronic rheumatism, in whatever form mani- 
fested, requires' the same general management as gout, the leading 
curative indication being to restore the general health. As constipation 
is an almost universal concomitant or antecedent circumstance, especial 
attention must, be given to the state of the bowels, which shoul 1 be 
kept free by means of injections, and an opening, plain diet. 

So long as the mercurial mania rages among the medical gentlemen 
of the allopathic school, so long will the hydropathic phyicinn be 
continually called upon to treat many anomalous varieties of chronic 
rheumatism, made such by the mercury with which the patient Ins 
been dosed in the treatment of some acute disease. Such patients are 
peculiarly sensitive to vicissitudes of weather, and do not bear as cold 
treatment as those whose systems have never been mercurialized. 
The wet-sheet pack, followed by the tepid half-bath, once a day, the 
tepid half-bath followed by the pail douche, and the occasional employ- 
ment of the warm-bath, followed by the pail douche or shower, consti- 
tute the best general plan of managing mercurial rheumatism. Some- 



128 PATHOLOGY AND THERAPEUTICS. 

times the treatment will set the remains of the mineral, which has long 
Iain dormant, as it were, in the system, in motion, and reproduce sali- 
vation, spongy gums, fetid breath, metallic taste, or other evidences of 
mercurial action. During this mercurial excitement, no very active 
cold treatment should be employed. The tepid sponge-bath, or half- 
bath, with such local applications as the local pains demand, the temper- 
ature being such as feels most agreeable to the part affected, may h" 
employed until the manifestations of mercurial action subside, when 
the regular treatment may be resumed. When the whole surface 
becomes extremely susceptible and sore, the hot-bath, followed by the 
tepid wash or pail douche, should be employed. 

The general regimen applicable to gout is equally so to rheumatism. 



CHAPTER IV. 

INDIGESTION. 



"Wherever the refinements of civilization and the luxury of plen- 
teousness exist, dyspepsia, in some of its protean shapes, seems to be the 
general condition of the inhabitants. I do not agree with Dr. E. John- 
son (Results of Hydropathy) that "constipation is not a disease of the 
bowels ;" nor do I coincide in his notion that mental excitement is the 
sole cause of indigestion. I admit, however, it is one among several 
very efficient causes of that extensive train of morbid maladies which 
we call dyspepsia. 

Nospjogists have enumerated more than one hundred distinct dis- 
eases, to which they have assigned specific characters, and which they 
have scattered through various and dissimilar genera, orders, and class- 
es ; yet each is nothing but a mere circumstance of deficient or imper- 
fect performance of the digestive function. Thus Dr. Good, in his 
elaborate system of pathology, eievates such symptoms of digestive 
derangement as heartburn, water-brash, flatulence, depraved appetite, 
colic, constipation, teething, etc., to the rank of idiopathic maladies. I 
shall undertake to associate all these manifestations of one general 
morbid condition into a more natural arrangement, and treat of them in 
the present chapter. The propriety of thus grouping together several 
classes of diseases which have been usually considered not only as idio- 
pathicMly di|tinctive hit ns demanding widely different and even oppo- 



INDIGESTION. 



129 



site methods of treatment, is enhanced by the fact that they nre all 
really cured by the same general plan of hydropathic medication 



Diseases of Indigestion. 



Dyspepsia < 



f Morbid Appetite, 
Morbid Thirst, 
Heartburn, 
I Flatulence, 
1 Constipation, 
I Sick Headache, 
f Chronic Hepatitis, 
Liver | Jaundice, 
Complaint 1 Gall-Mtones, 
I Duodenitis. 

{Toothache, 
Tartar of the Teeth, 
Excrescent Gums. 
/■Iliac Passion, 
Painter's Colic, 
Wind Colic, 
Co!ic ] Surfeit, 

Constipated Colic, 
I Constrictive Colic. 



Cholera 



(■Bilious, 
j Flatulent, 

1»p 



spasmodic, 

I I Infinitum. 

r Feculent, 

| Bilious, 

J Mucous, 
Diarrheal Mi]ky) 

Serous, 
Tubular 

{Bezoar, 
Calculus 
ricybalum. 
{ A] vine Worms, 
Anal Worms, 
Erratic Worms. 
i Blind Piles, 
Bleeding Piles. 
White Piles, 
Caruncular Piles. 



That the majority of'the diseases named in the above' table are 
symptomatic of indigestion all will allow ; but those who are accustom- 
ed to regard worms as natural to the alimentary canal, and those who 
consider the piles as a local affection, will object to the tabular arrange- 
ment. But I will venture to assure every physician who will carefully 
investigate the subject, that he will find the stomachs and bowels of 
children or adults infested with vermin in very nearly the ratio that 
foul secretions and crude ingesta evince disordered digestion ; and if 
he will attentively study the history of hemorrhoidal affections, he will 
find them, in some form, almost as general as, and almost invariably 
preceded by, constipated bowels. Still greater will be the dissent of 
those who have imagined epidemic or spasmodic cholera to depend on 
specific contagion, ozone, electrical or magnetic states of the atmos 
phere, or planetary or other unearthly influences, to the idea that all 
the choleras of medical books are dyspeptic affections. But, whatever 
may bo their predisposing or exciting causes, it is sufficiently apparent 
that the actual condition of the disease is that of extreme derangement 
and intense irritation of all the- organs auxiliary to digestion. 

Dyspepsia. Depraved appetite, unnatural thirst, flatulence, acrid 

eructations, heartburn, or water-brash, irregular bowels, rtnd sick head- 



130 PATHOLOGY AND THERAPEUTICS. 

ftche, are among the multitudinous symptoms of dyspepsia ; yet, the 
disease may exist with the absence of either one or the majority of 
s.hem. 

Symptoms. — Fastidious or irregular appetite, constipation, or diar- 
rhea, or those states alternating, sense of weight or other feeling of 
distress after eating, food digested with difficulty, depressed spirits, 
disturbed sleep, occasional pain or tenderness in the epigastrium, a 
feeling of languor, which is relieved by taking food, aversion to exer- 
cise of body or mind, are symptoms which, variously combined, desig- 
nate the disease. Usually thera is occasional palpitation or throbbing 
of the heart, furred tor.gue, and slow, irregular, or intermittent pulse. 

Doctor Gully and some other authors distinguish dyspepsia into the 
nervous and mucous varieties. The term, nervous, is applied to the 
disease when occurring in persons of irritable temperaments, with a 
large development of the brain and nervous system; and* the term, 
mucous, is applied to the disease as it appears in persons of more tor- 
pid or phlegmatic temperaments. The former generally results from 
nental shocks, excessive emotions, intense study, violent passions, and 
is attended with great pain or uneasiness in the stomach, spasms, gnaw- 
ing or sinking sensations, capricious appetite, etc. The latter results 
more especially from sedentary habits and excesses in eating and drink- 
ing, and is attended with torpid bowels, and but little actual pain in the 
digestive organs. 

Treatment. — No other disease presents itself under so great a va- 
riety of complications ; and although the principles which regulate its 
treatment are very simple, there is an unlimited opportunity for the 
exercise of skill and tact in the management of a dyspeptic invalid. 
Usually we have to deal with fickle tempers, despondent minds, strong 
morbid appetites with weak resolutions, all of which circumstances are 
aggravated -by the patient having previously doctored with all sorts of 
doctors, and swallowed every thing he could read of in the newspapers 
in the shape of nostrums. 

All the resources of hygiene must be drawn upon, and adapted to 
the circumstances of each particular case. The nervous, feeble, rest- 
less individual, who is all activity with little strength, who has a con- 
stant disposition to move with no power to endure, must take moderate 
water-treatment, exercise gently, prefer sailing, riding, etc., to active 
walking, and sleep all that he is inclined to, even though it be late in 
the morning, or at other times of day ; while the torpid, quiet, but 
more enduring person should employ more powerful water processes 
rise early, walk much, and practice gymnastics for amusement, unless 
fee fan fin amusement in some light kind of manual or mechanical labor 



INDIGESTION. i 31 



The diet should be more plain and simple as the disease is more ad- 
vanced and serious. Regularity in the alvine dejections is of first im- 
portance. The patient should, if possible, go to stool at the same time 
of each day, and if the diet does not, in a very few days, produce 
regularity in the discharges, cool or cold injections should be employed 
daily, soon after rising. As a tonic effect is always desirable, cool or 
cold water should be employed, whether the bowels are loose or con- 
stipated, except when affected with colic or griping. The sitz-barh 
and the abdominal compress are the important and ever-necessary local 
baths. The former may be resorted to two or three times a day, for 
ten oi- fifteen minutes, the temperature as cold as the patient am bear 
without producing a permanent chill, or disagreeable feeling of weak- 
ness and stiffness. The crash towel bandage is the best ; the wet part 
should pass round the body, when it can be worn without unpleasant 
irritation cr chilliness of the back; otherwise it should only extend 
ncross the abdomen from one side to the other. Foot-baths should not 
be neglected when there is a tendency to cold extremities. The most 
important general baths are the partial or complete wet-sheet pack, 
according to the general heat and reactive power, and the tepid half 
or shallow-hath. The plunge or douche may be employed under the 
restrictions heretofore specified ; the dripping sheet is a good substitute 
for either of the other general baths when it is impi-actieabie. 

The hot fomentation to the abdomen is serviceable whenever indi- 
cated by severe headache, spasms, general restlessness, nausea, vomit- 
ing; and sick headaclie is relieved by drinking warm water, followed 
by sips of cold, and, in severe cases, the abdominal fomentation. When 
sick headache occurs periodically, warm water should be copiously 
drank on its first attack, to dilute and wash away the offending bile or 
other acrid fluids as soon as possible. 

A good combination of baths for full or active treatment in an ordi- 
nary case, would be the following daily : Tepid half-bath five minutes 
and pail douche ; wet-sheet pack, followed by moderate douche, plunge, 
or dripping sheet ; sitz-bath at 60°, ten minutes, followed, after an hour's 
interval, by a foot-bath at 72°, five minutes ; the first to be taken on ris- 
ing ; the second from ten to eleven a.m. ; the third at four to five p.m., 
and again jn the evening. The wet girdle should be wet and reapplied 
after each bath, and again at bedtime. In protracted cases requiring a 
long course of treatment, it is advisable to omit the wet bandage occa- 
sionally for a few days, and then resume it again. 

In many cases of dyspepsia there is a weak and relaxed, or a rigid 
and contracted state of the externa] abdominal muscles, especially fre- 
qnent in those who have been addicted to crooked bodily positions, in- 



182 PATHOLOGY AND THERAPEUTICa 

tense mental excitement, sexual abuses, or the use of narcotic stimu- 
lants, as tobacco and alcohol. The free indulgence in tea and. coffee 
also conduces to it ; and fine, constipated food is among its producing 
causes. These cases require local manipulations, *as kneading, pound- 
ing, rubbing, etc., the lower part and external muscles of the abdomen, 
not with sufficient violence, however, to cause pain. A trotting horse 
affords a good exercise. Climbing mountains, and walking rather fast 
over an uneven surface, are also peculiarly beneficial exercises. 

Liver Complaint. — A morbid condition of the liver is as constant 
and as necessary a concomitant of indigestion as is a morbid condition 
of the stomach. In some forms of deranged digestion the stomach 
and bowels appear to be the seat of the more prominent morbid phe- 
nomena, and in others the liver presents evidences of being dispro- 
portionately affected. Its pathological conditions are various, but its 
functional derangements may all be comprehended under the general 
term of liver complaint. 

Symptoms. — Chronic hepatitis is a state of passive or chronic inflam- 
mation of the organ. In addition to a variety of dyspeptic sj'mptoms, 
there is sense of weight, fullness, or other pain in the region of the 
liver, which is increased by deep pressure ; sometimes the pain is re- 
ferred to the left side ; at other times to the right shoulder, or between 
the shoulder-blades ; there is frequently darting, irregular, and fugitive 
pains along the breast-bone and through the chest ; some degree of 
enlargement or hardness is usually obvious to the touch under the 
6hort ribs of the right side ; the countenance is sallow ; the bowels are 
costive ; the stools are clay-colored ; the patient is torpid, inactive, and 
desponding, and there are occasional attacks of jaundice. Dropsy fre- 
quently follows this form of diseased liver. It is also generally attended 
with a dry, husky cough, and a slight hawking, or spitting of a thick, 
tenacious mucus, especially in the morning, when the sputa appears 
dark and carbonaceous, as though charcoal-dust had been diffused 
through it. The cough is immediately caused by the engorged or 
swelled liver pressing upon the diaphragm, and the viscid secretion of 
the mouth or throat is owing to the irritation of congested and acrid 
bile. This cough and expectoration may be distinguished from that 
which has its seat in the lungs or their appendages, by the slow pulse, 
and the prominent hepatic or dyspeptic symptoms. 

Jaundice — the icterus of tire books — has been commonly distinguished 
into the yellow and black, or green, according to the discoloration of the 
skin from impacted and partially patrescent bile, to which some authors 
have added the subvarieties of biliary — p -duced by n resorption 'of 



INDIGESTION. 



bile; gall-stone — resulting from obstruction of the bile- ducts from in- 
spissated bile; spasmodic — produced by spasmodic stricture of the bile 
ducts; hepatic — resulting from schirrus or induration of the liver; in 
fantilc — occurring in infants; and black vomit — the regurgitation of 
morbid bile into the stomach, and its ejection, mixed with dark, gru- 
mous blood. Jaundice, in a general sense, is known by debility, languor, 
inactivity, heat and pricking of the skin, bitter, nauseous, or acrid taste 
in the mouth, yellowne^ of the conjunctiva of the eye, and subse- 
quently of the whole surface of the body ; the bowels are irregular, 
the urine high-colored and yellowish, the pulse is usually slow and 
weak, the mind is downcast and gloomy, or listless, wandering, and 
irritable, and there is feverish heat and dryness of the skin. When 
the disease is protracted, the skin turns greenish, brown, livid or lead 
en, blotches appear in different parts, and the discharges from the 
bowels are dark, pitchy, and bloody. The special or immediate cause 
of jaundice is torpor or inactivity of the liver, by which the viscid par- 
ticles which should be secreted in the liver, and passed off in the form 
of bile, are left in the blood. • 

The existence of gall-stones is known by the acute and sometimes 
excruciating pain they occasion when passing through the common 
bile-duct from the liver into the duodenum; this pain is felt in the 
epigastrium, extending to the right side a'nd back, and occurs in severe 
paroxysms, with intervals of comparative ease. The pain suddenly 
remits when the calculus reaches the intestine. 

Duodenitis is an inflammatoiy state of the mucous membrane of the 
duodenum, at the point where the bile enters this portion of the intes- 
tinal tract ; it is occasioned by the contact of acrid and irritating bile, 
and known by a sickening, sinking, gnawing sensation just below the 
pit of the stomach, with tenderness to external pressure, often so great 
as to make the weight of the hand or of the bedclothes painful. 

Treatment. — All that has been said in relation to the treatment of 
dys.pepsia, applies with equal force here. There are, however, some 
modifications of the general plan of management required in some 
forms and stages of the disease, or rather group of diseases under con- 
sideration. The state or condition of liver disease described as chronic 
hepatitis, in which the bile is still imperfectly secreted, but its quality 
exceedingly vitiated, requires more especial attention to the stomach 
and bowels. Warm water emetics are serviceable to deterge the biliary 
ducts, whenever nausea, bitterness in the mouth, and unusual sense of 
fullness in the right side indicate obstruction ; and if the bowels are 
eostive, with general fullness and tenderness, tepid injections should be 



184 PATHOLOGY AND THERAPEUTICS. 



freely employed until these symptoms are removed, when cool or cold 
•nes should be substituted. 

Jaundice presents many complicated varieties of morbid phenomena, 
all of which are usually denominated "nervous debility;" a term not 
entirely inappropriate, since the thick viscid blood, consequent on the 
retained matter of bile, being unable to penetrate freely the minute 
capillary vessels, where nutrition of the nervous, as well as the other 
structures, is effected, the nerves are really impoverished for want of 
sustenance. In this form of diseased liver, too, the skin is dry and 
feverish, or clammy and cold, in either case weak, obstructed, and bil- 
ious, yet bloodless. Reaction, though sometimes active and prompt, is 
always feeble and transient; hence we are to begin the general treat- 
ment with the gentler processes, employing water of a mild temper- 
ature, gradually intensifying the force and lowering the temperature 
of the baths, as the superficial circulation of tile patient improves. 
The half-bath may be commenced at about 85° or 90°, and gradually 
reduced to 75° or 70°; the sitz may be employed at first at 75°, and by 
degrees lowered to 60°; the eold sheet half-pack, or entire warm sheet 
pack, is advisable at first, gradually proceeding to the ordinary wet- 
sheet envelopment as the skin becomes invigorated. In some cases, 
where there is considerable tendency to feverishness, the whole body 
will readily warm up in the wet sheet, and the glow increase for 
twenty or thirty minutes, when it will begin to decline, in spite of anj 
amount of extra bedding. Such patients should be taken out of the pack 
as near the height of the reaction as possible, and bottles of hot water 
should be applied to the feet, and in extreme cases to the armpits also, to 
enable them to remain still longer enveloped. The dripping rub-sheet 
is one of the best appliances in cases of extreme torpor and bloodless- 
ness of the surface, the temperature not being so cold as to leave a 
permanent chill. 

It should be particu inly borne in mind, that no patients in the con- 
dition of " nervous debility" under consideration, will tolerate extremes 
of treatment, be they hot or cold. There is not sufficient blood in the 
superficial capillaries to react against very cold impressions, and for the 
same reason steam or vapor-bathing, or the ordinary hot-bath, has a 
peculiarly relaxing and debilitating effect, a vigorous capillary circulation 
being just as necessary to defend the body against one extreme of tem- 
perature as another. 

The existence of gall-stones only requires the hot fomentation and 
warm sitz-bath, with copious warm water drinking, to facilitate their 
passage, and mitigate the pain. 

As dnodenifis is cansed directly by morbid nnd acrid bile it will dia 



INDIGESTION. 135 



appear whenever the healthful secretion of the liver is restored. Some- 
times it disappears when the condition of the liver changes from chronic 
inflammation to jaundice — from morbid action to no action. Occasion- 
filly ulceration takes place from the long-continued corrosive effect of 
putrid bde, resulting in death suddenly and unexpectedly. 

MrsDENTiTioN.— Teething, tooth-edge, toothlessness, and deformity 
of the teeth, are placed by Dr. Good in the catalogue of diseases be- 
longing to the genus before us. Teething, it seems to me, is rather a 
natural than a morbid process ; and, although often accompanied with 
much pain and suffering, and various diseases, these are all owing to 
some obstruction or irritation in the digestive organs, producing a gen- 
eral feverishness of the system and an inflammatory state of the gums. 
Tooth-edge is the peculiar tingling or uneasy sensation experienced in 
the teeth from some kinds of grating or jarring noises, or from certain 
acids and acrid substances. ToothUssness results from constitutional 
defect, external violence, internal drug-medicines, decay, or old age. 
Deformity of the teeth is generally an unfortunate inheritance, for which 
the child is indebted to the bad dietetic or other habits, or infirmities, 
of one or both parents ; a great degree of deformity, however, may 
be produced by bad habits in the dietetic and medical management of 
the child itself. 

The diseases properly coming under the present head are, toothache, 
tartarous teeth, and excrescent gums, all specially connected with or 
dependent on depraved or impaired digestion. The history of all the 
animal creation, and of the whole human race, shows that there is a 
most intimate relation between sound, clean, symmetrical teeth and 
healthy, fine, vigorous gums, and correct dietetic habits. The uni- 
formly healthy condition of the teeth of wild animals, and the general 
rotting state of those of domesticated animals illustrates this fact suf- 
ficiently. 

The exciting cause of toothache is usually "taking cold." It may 
exist in connection with caries or ulceration of the teeth, or with ex- 
treme irritability of the dental nerve without structural 'decay. The 
cure may be found in holding tepid or cool water in the mouth, renew- 
ing it as often as it becomes quite warm, rubbing the face and neck 
with the hands dipped in cold water, the shallow foot-bath, and absolute 
fasting until the pain abates. Very few toothaches can hold out against 
a fast of twenty-four hours, even if no other medication is resorted to. 
Rubbing the teeth and gums smartly with a brush dipped in cold water, 
even until the gums bleed freely, often relieves toothache promptly. 

Tartar of the teeth consists yt concrete saliva hardened by the earthy 



136 PATHOLOGY AND THE ft A P E UTIC & 

materials which it secretes. The remote cause is undoubtedly the 
excessive amount of earthy 01 extraneous ingredients taken into the 
system with the food and drink, more especially derived from hard wa- 
ter ; and the immediate cause is deficient mastication, the food being soft 
and sloppy, and not demanding sufficient exercise of the teeth to keep 
them clean. In many instances the mouth is most foully disfigured by 
tartarous concretions which have destroyed the gums and alveolar 
sockets. The tooth-brush, aided by some mild dentifrice, is the best 
palliative we can employ. To effect a cure, the teeth must be cleaned 
by a careful dentist, and then the dietetic habits must be placed under 
physiological law. 

Excrescent gums may be either soft, spongy, or fungous, or in the 
form of firm, unyielding lumps or Hardened knobs; they are always 
symptomatic of scurvy, or some disorder of the digestive organs. They 
can only be cured by attention to the general health. Sometimes the 
excrescences, when considerably protuberant, have been extirpated 
with caustic, ligature, or the knife ; but unless general health is re- 
stored, they will soon grow again. 

Colic. — All those diseases comprised under the generic head of 
cholic, or belly-ache, are characterized by griping pain in the bowels, 
mostly in the region of the umbilicus, and attendea with vomiting and 
costiveness. 

Symptoms. — The species called iliac passion is accompanied with 
painful retraction or drawing in of the navel, and spasms of the muscles 
of the belly ; the vomiting is exceedingly violent, ejecting bile from the 
duodenum, and often stercoraceous matter from the bowels; and even 

some cases the injections introduced into the rectum have been 
ejected by the mouth. This is the disease called introsusception or in- 
tussusception in medical books, and so denominated from the circum- 
stance that one portion of the affected intestine, constringed and les- 
sened in diameter, has fallen into another. 

Painter's, colic — known also as Devonshire colic, colica poictou, and 
colica rachialgia — is so termed from the remote cause being the in- 
troduction of lead into the system, and hence mostly confined to paint- 
ers. In the neighborhood of smelting furnaces, pigs, poultry, and othei 
animals are said to be affected with this complaint. It is evinced by 
a pain at the pit of the stomach, at first dull and remitting, but grad- 
ually becoming more violent and continued, and, as it increases, ex- 
tending upward to the arms, and downward to the navel, back, loins, 
rectum, and bladder, and frequently extending to the thighs and legs. 
From the navel it sometime? shoots with so much violence to oich side 



INDIGESTION. 137 



that the patient feels as if some person were cutting him in two. The 
external muscles are extremely sore and tender, and can scarcely 
bear the slightest touch. Momentary relief is occasionally experienced 
after the vomiting of acrid bile and slime, but the pain soon returns. 
In about a week or less, if recovery takes place, relieving sweats 
appear, and the bowels discharge large quantities of excrement, con- 
sisting of hard lumps, or scybala, mixed with blood and dirt'colored 
mucus, after which the patient is convalescent. Paralysis of the fingers, 
hand, and arm comes on after several attacks. 

It may be poor consolation to wine-bibbers to know that litharge, and 
other preparations of lead, are extensively employed in the manufac- 
ture of sweet and sub-acid wioes, and that where such wines are freely 
drunk, this kind of colic is very prevalent; nevertheless, such is the 
fact. 

Dr. Samuel Cooper, author of a surgical dictionary, remarks : " Dur- 
ing the sixteenth and seventeenth centuries, when preparations of lead 
used to be given in large doses medicinally, the colica pictonum and 
paralysis, in their severest forms, appear to have been very frequent." 

Wind-colic — colica fiatulentia — is evinced by acute pain extending to 
the pit of the stomach, accompanied with great fullness and flatulence, 
often impeding respiration; it is relieved by pressure, expulsion of 
wind, or bending the body forward. It is chiefly produced by crude 
or unripe fruits, long fasting, grief, fear, etc., and is a frequent attend 
ant of dyspepsia and chronic diarrhea. 

Surfeit — colica cibaria — is usually produced by loading the stomach 
with an excessive quantity or indigestible quality of food. Occasionally 
it results from poisonous vegetables or animals taken into the stomach. 
Various kinds of shellfishes, and several species of other fishes, are 
known to have been followed by an attack. It is characterized by pain, 
nausea, and dizziness, until vomiting takes place, terminating afterward 
in a griping looseness. There is also, in some cases, an eruption of the 
skin, with constriction in the throat, an intolerable sense of suffocation, 
swollen eyes, extreme thirst, and a burning heat over the whole surface. 

Constipated colic — colica constipata — is caused by indui'ated faeces, 
or other intestinal concretions, and is known by severe griping pain, 
obstinate costiveness, great tension with little flatulence; the vomiting 
sometimes accompanied with fceces ; the costiveness is attended with 
bloody strainings, terminating, when not fatal, in a free discharge of the 
iufarcted matter. 

The constrictive species — colica constricla — results from a permanent 
stricture existing in some part of the alimentary canal. Its symptoms 
are — a sense of stricture ; a fee ing of flatulence gradually passing ofF 



1S8 PATHOLOGY AND THERAPEUTICS. 

by the stricture; the bowels taidy, and discharging with difficulty 
small liquid stools. In the early stage of the disease there are colic 
pains and costiveness, alternating with bilious diarrhea; after the dis- 
ease has existed some time, solid feces are rarely passed, and only 
after a great effort, and they are of an extremely slender caliber. Pa- 
tients have been known to subsist more than thirty days without any 
evacuation from the bowels. 

Treatment. — The general management of colic consists mainly in 
the employment of copious warm water injections, to free the aliment- 
ary canal of its accumulated contents, conjoined with frequent hip or 
half-baths, which may be either hot or cold, according to circumstances, 
to quiet pain, and overcome whatever inflammatory or spasmodic con- 
dition may exist. In some cases, hot water proves the best sedative, 
and in other cases, very cold water is most efficient. It is fortunate 
that in almost all cases, and probably in every case, when warm water 
fiils in giving relief, cold water promptly succeeds. The desirable 
temperature can generally be very readily determined by the febrile 
or non-febrile character of the symptoms. If there is considerable 
heat and fixed soreness about the abdomen, with a general feverishness 
of the whole body, cold or very cold water is most appropriate ; and 
when the whole body is- inclined to coldness and torpor, and the ab- 
dominal pains are griping and periodical, hot water is indicated. In 
mild cases, the hot fomentation, followed by the cold compress, will 
remove all local distress. Wherever the hip or half-bath is employed, 
the abdomen and back of the patient should he thoroughly rubbed dur- 
ing its administration. The moderate drinking of water, or tepid water, 
assists the relaxant effects of the other processes. 

In the first-named variety— colica ileus — the stricture of the intestine 
is sometimes so great as to piuduce a degree of strangulation, liable to 
be followed by inflammation and gangrene, especially if drastic or irri- 
tating purgatives are resorted to, as they generally are in old-school 
practice. The foeces in this, as in the other forms of colic, ma}' be so 
hardened as to require the handle of a spoon, or some similar contriv- 
ance, to remove them from the rectum. For these reasons, as large a 
quantity of water as the bowels can well receive should be injected, 
and the process frequently repeated. The warm stream douche, fol- 
lowed by the cold dash, is excellent as a local application. 

The second variety — painter's colic — demands, in addition to all the 
treatment required for the ileus form, thorough detersive and invigora- 
ting management. The wet-sheet pack, cold or. warm, according to 
the external heat or cok'ness of the patient, followed by the dripping 
wet-sheet or towel -wash and this by the dry sheet and dry hand rub- 



INDIGESTION. i 3D 



bing, will best accomplish the cleansing and strengthening part of the 
remedial plan. 

The third variety — wind, or flatulent colic — the hot fomentation and 
a single injection are usually sufficient to remove. If it resist these 
means, the warm douche to the abdomen, followed by the dash of a 
pail of cold water to the belly and legs, will elfectually disperse it. 

The fourth variety — surfeit — requires a thorough warm water emetic, 
a free injection, and a rigidly-abstemious diet, or absolute abstinence, 
for a few days. 

The fifth and sixth — constipative and constrictive — forms, are cured 
by a frequent and persevering employment of tepid injections and 
sitz-baths, as leading processes, assisted by hot fomentations, the wet- 
sheet pack, and other appliances, as the general symptoms indicate. 
Especial attention should be given to rubbing, kneading, gently pound- 
ing, or otherwise exercising the muscles of the loins and abdomen. 
The diet should be of the coarsest kind— cracked-wheat, rye.-mush, 
Indian gruel, hard wheat-meal biscuits, good fresh ripe fruits, etc. 

Cholera. — The group of diseases comprehended under this generic 
term, is characterized by vomiting and purging, gripings in the bowels 
spasms in the arms and legs, often flatulent eructations and dejections, 
with great anxiety and prostration. Th:-; usual succession of symptoms 
is — Vomiting, purging, spasms, prostration, and collapse. In the spas- 
modic cholera, however, the vomiting is generally preceded for hours 
or days with looseness or diarrhea. Cholera is distinguished from colic 
by the presence of purging, and from diarrhea by the absence of vom- 
iting in the latter disease. 

In the bilious variety — commonly known as cholera moihus — the 
vomiting and purging are copious and frequent, with a redundancy of 
bile. In the severest cases the vomiting is vehement, the dejections 
very painful, the spasms violent, and the agony intense. In the worst 
cases the extremities are cold, the pulse is small, frequent, and un- 
equal, and the patient sometimes dies within twenty-four hours from 
the first attack. The exciting causes are usually a surfeit, acrid bile, 
indigestible articles of food, drastic purges, emetic drugs, especially 
tartar emetic, etc. 

The flatulent form — wind cholera — is particularly characterized by 
the absence of bile in the discharges; the vomiting and purging are 
rare ; but in their stead there is great and oppressive flatulence and 
retching, with windy eractations and dejections. This form of the dis- 
ease is rather peculiar to dyspeptics. 

Spawodic cholera — called also malignant, epidemic, Asiatic, Indian, 




140 PATHOLOGY AND THERAPEUTICS. 

blue, and pestilential cholera — is generally epidemic, though not con- 
tagious. The first symptoms are usually experienced during the night, 
sometimes commencing with a slight general uneasiness and moderate 
diarrhea; at other times the symptoms come on violently, and follow 
each other rapidly. In fatal cases death usually occurs at some period 
between six and twenty-four hours ; in a few fatal cases the patient 
lingers two or three days. The ordinary course of symptoms is, more 
or less diarrhea; the discharges at first fe^Ment, but soon presenting 
the appearance of rice-water or gruel ; there are flying pains, or sense 
of coldness in the abdomen, as if purgative medicine were about to 
operate ; the countenance is pale ; there is nausea, vomiting, prostra- 
tion of muscular power, and nervous agitation ; cramps in the legs, 
arms, loins, and abdominal muscles, more or less severe ; small weak 
pulse, intense thirst, and urgent desire for cold water ; in most cases 
cold, clammy skin ; all these symptoms may appear successively or al 
most simultaneously. In some cases the premonitory symptoms exist 
for eight or ten days ; and sometimes the patient is prostrated at once. 
When the disease comes on suddenly, the cramps usually commence 
in the fingers and toes, rapidly extending to the trunk ; the eyes are 
sunken, and surrounded by a dark circle ; there is vomiting and purg- 
ing of white matters mixed with flocculi ; the features are sharp and 
contracted ; the expression of countenance wild and confused. The 
face, extremities, and often the whole surface of the body, manifest a 
varying intensity of a leaden, bluish, or purplish hue ; the extremities 
are shrunk, the nails blue, the pulse thready or wholly imperceptible 
at the wrist, arm, axilla, temple, or neck ; there is great restlessness, 
incessant jactitation, severe pain in the epigastrium, loud moaning or 
groaning, difficult and oppressed breathing; difficult inspiration, with 
short and convulsive expiration; voice hoarse, whispering, or nearly 
■suppressed and plaintive; the tongue is white, cold, and flabby, and the 
external temperature often sinks below 80° ; convulsions recur at short 
intervals, or a constant tremor exists. The secretions of bile, saliva, 
tears, and urine are entirely suppressed, and a cadaverous odor exhales 
from the body. The patient retains his faculties to the last. 

Either of the above symptoms may be disproportionately severe, or 
it may be entirely absent. Those usually regarded as pathognomonic 
are, watery dejections, blue appearance of the countenance or sur- 
face, thirst, coldness of the tongue, and pulselessness at the wrist. 

The fourth variety — cholera infantum — is peculiar to infants, and 
prevails extensively during the warm season in nearly all of our cities. 
In ordinary cases the diarrhea precedes the vomiting for several days ; 
but in severe ones vomiting also occurs from the beginning. The dia- 






INDIGESTION. 



1*1 



charges at first are composed of ordinary fcecal matters ; but, as the 
disease progresses, they become watery and variously colored, from a 
dirty white to a brownish, and sometimes greenish hue. Sometimes 
these discharges are frothy, like yeast, and mixed with the food, which 
passes the bowels almost unaltered ; in some cases the discharges are 
bloody, as in dysentery. There is raging thirst, the tongue is dry, but 
scarcely furred; the febrile heat is very irregular; the body emaci- 
ated; the skin grows dry and ash-colored; the abdomen is very much 
heated toward the termination of the disease ; the pulse is small, 
weak, and frequent throughout. It usually runs its course in about 
three weeks. 

Treatment. — Bilious cholera ii: its early stage requires copious warm 
water injections, and free warm water-drinking, to cleanse the whole 
alimentary canal as promptly as possible. When the discharges have 
existed for a considerable time, and the patient is greatly exhausted, or 
after the employment of the cleansing processes above named, frequent 
sips of cold water should be taken, and moderate cool injections em- 
ployed after each dejection. The cold compress should be applied to 
the abdomen, and very frequently changed. When the griping is ex- 
treme, the hot hip-bath should be resorted to ; and the cold hip-bath 
when there is much external heat and tenderness of the abdomen. 
The wet-sheet pack and the pouring head-bath are appropriate and 
very efficacious, and often magically soothing processes, after the 
stomach and bowels are freed of their irritating contents. 

The flatulent form may be relieved by hot fomentations or hip-baths, 
and moderately cool injections. 

In indicating the appropriate hydropathic treatment for spasmodic 
cholera — the most frightful, yet not the most fatal pestilence of mod- 
ern times — I feel no small degree of embarrassment ; not that I regard 
the Water-Cure, which I claim to be a sufficient system in all other 
functional diseases, as an exceptional failure in this, but because it has 
no power to reclaim the dead ; and in many cases an attack of this 
disease is a death-stroke. Persons of gross habits, the intemperate, 
the debauchee, the riotous liver, and those whose dietetic habits have 
been peculiarly enervating and constipating, are especially and almost 
exclusively the subjects and the victims of this penal scourge. The 
nature of the disease is an intensely irritated or peculiarly inflamma- 
tory state of the mucous membrane of the stomach and bowels ; the 
diarrhea, which the drug-physicians regard and treat as though it were 
the essential disease, being a mere indicent, effect, or symptom of this 
general morbid condition. That debility and obstruction in the primary 
nutritive functions constitute the essentia! condition, while inflammatory 



142 PATHOLOGY AND T!I Ell A P EU TIC S. 

notion and serous discharges constitute the leading manifestations of the 
disease, is rendered probable, if not proved, by the fact, that no indi- 
vidual of correct dietetic habits — such habits as are advocated in this 
work — ever yet had the disease. This is certainly true of the Gra- 
hamites and Vegetarians of New York, in all the seasons — 1832-34 and 
1S49 — that it has prevailed epidemically; and as far as T can learn — 
and I have taken no little pains to ascertain the fact — throughout the 
wide world. 

When I say that dietetic errors are prominent among the producing 
causes of malignant cholera, I do not mean exclusively habits of glut- 
tony and intemperance. . Many persons, intending to diet preventively, 
have dieted in exactly the way to produce it. Medical councils, boards 
of health, and sanatory committees have generally given authoritatively 
more bad than good advice, both as respects avoiding the disease and 
curing it. The preventive measures officially recommended in New 
York in the hoi season of 1849, consisted mainly of "flannel next the 
skin, the warm bath occasionally, a greater proportion of animal food, 
and fine, constipating, farinaceous food." Under the delusion that "the 
diarrhea was the cause of all the symptoms which followed, and that 
if the diarrhea could be prevented, no cholera could occur," rice, 
dried beef, bakers' fine bread, with animal food two or three times a 
day, and the almost entire prohibition of fruits and vegetables of all 
kinds, became substantially the preventive plan of living — a plan which 
was faithfully followed, even unto death, by many persons and several 
physicians in this city. The true preventive plan is exactly the oppo- 
site in every respect. 

The drug treatment of cholera would be amusing for its inconsisten- 
cies, did its consequences not border so closely on the tragical. A 
great variety of plans of medication, directly opposite to each other, 
have been tried with equal success, which fact ought to be, conclusive 
with every unprejudiced mind that the" whole is purely empirical. Let 
us place a few of the opposite plans o( treatment recommended to us 
on high authority in juxtaposition : Blet.ling and antimony— opium and 
brandy; copious libations of cold water— powerful internal stimulants, 
as capsicum and cajeput oil; emetics of mustard, ipecac, antimony, 
and blue vitriol— iced-water, or bits of ice, to allay sickness at the 
stomach; cathartics, as calomel, castor-oil, colocynth, jalap, colchicnm, 
and iroton oil— astringents, as sugar of lead, lime-water, and nitric 
acid ; hot water, fomentations, dry heat, wine, and alcohol— cold water, 
solutions of potash, soda water, and effervescing draughts; mustard 
plasters and blisters to the stomach, caustics to the spine — large doses 
of opium and strychnine; inhalation of oxygen gas — injections of saline 



INDIGESTION. i\% 



solutions into the veins ; galvanism and merturia frictions — tobacco, 
and the exhausted air-bath, etc., etc. 

In the early stage of the disease, a free injection of tepid or rather 
warm water should be administered frequently; meanwhile the thirst 
should be assuaged, and the heat of the stomach mitigated with frequent 
but moderate draughts of cold water, or bits of ice, and the cold com- 
press to the abdomen, well covered with dry, soft flannel. Before the 
surface becomes very cold, or the patient sinks into collapse, the drip- 
ping wet sheet, followed bj the dry sheet, and both accompanied with 
active and persevering friction, should be employed; the wet sheet 
pack also works admirably in the early stages. If the patient is too 
weak to bear these processes, and in the later or collapsed stage, the 
surface should be well rubbed with a cold wet towe". and this succeeded 
by active friction with dry soft flannel or the dry hand ; the injections 
should then be frequently employed, but of cool water, and moderate 
iu quantity. In the very outset of the disease, provided there is much 
nausea and retching, I would employ a brisk warm water emetic, and 
follow it with sips of cold water according to the degree of thirst ; the 
cool or cold hip-bath is also a valuable assistant in any stage of the dis- 
ease preceding the collapse. When the spasms are violent, the 
external friction should be proportionally vigorous. In bad casee, two 
or ihree stout, active attendants ought to work upon the patient by 
means jf wet and dry rubbing alternately, so as to promote the super- 
ficial circulation as much as possible, and thereby relieve the internal 
congestion. 

Cholera infantum is generally easily cured by cool injections, the 
abdominal compress, and the tepid towel bath or ablution, as often a8 
the surface manifests any considerable feverish heat. The patient 
may drink of pure water according to thirst. When the evacuations 
from the bowels are mixed with blood, the injections should be quite 
cold. In protracted cases, the child should be placed, once a day, 
when the fever is highest, in a tepid half bath and the abdomen, back, 
chest, and even extremities well rubbed wiui the bare hand. The 
food must be exceedingly sin.rie. Wheat meal mush and rice, seasoned 
with a little sugar or milk, are the best articles. 

Diarrhea.— The group of diseases properly arranged under this 
head are characterized by frequent and copious discharges by stool, 
with a sense of weight and uneasiness in the lower belly, and without 
severe griping or tenesmus; nausea and vomiting are occasional, but 
not usual incidents. All forms of diarrhea may become cnronic, in 
which event there is great emaciation. 



lit PATHOLOGY AXD THERAPEUTICS. 

In the feculent variety — diarrhea fusa — the foeces are of common 
quality, but simply loose and copious. 

The bilious variety — diarrhea biliosa — is only distinguished from the 
former by the bright yellow color of the discharges. 

In the mucous form — diarrhea mucosa — the dejections consist mainly 
of, or contain a large quantity of mucus. This affection has sometimes 
been called catarrhal diarrhea. 

The white looseness — diarrhea alba — is characterized by dejections 
of a milky color, resembling a mixture of water and lime, with a frothy 
scum. This has been called chylous diarrhea bj' some authors, on the 
mistaken supposition that the non-absorption of chyle was its imme- 
diate cause. It is chiefly found in persons whose digestive powers 
have been shattered by severe fevers ana severer drugs, and by ex- 
cessive indulgence in stimulating food or drink, or narcotic irritants, as 
alcohol and tobacco. 

In the fourth variety — called lientery — the dejections consist princi- 
pally of undigested aliment, which passes rapidly through the aliment- 
ary canal, with but little ^change. 

In the serous variety — diarrhea aquosa — the discharges are almost 
entirety limpid and watery. 

Tubular diarrhea is known by discharges consisting more or less of 
membrane-like tubes, or fragments of membranous tubes, which are 
whitish, viscous, and inodorous. This membranous secretion is of the 
same nature as that which takes place in the mucous surface of the 
trachea in cases of croup. Its expulsion from the bowels often alarms 
the patient, who mistakes it for a portion of the bowel itself. In some 
instances, membranous tubes half a yard in length have been evac- 
uated. 

Treatment. — In a general sense, the treatment of diarrhea, when 
protracted or chronic, is essentially the same as for dyspepsia, of which 
il is mostly symptomatic. The feculent form, being occasioned by ex- 
cess in quantity, or an irritating quality of food, requires no medication 
save the negative remedy — fasting. Bilious looseness is readily relieved 
for the time by one or two copious tepid injections. All the other 
forms must be treated on general principles ; the local irritation may 
be relieved by sitz^baths, cold injections, cold compresses, hot foment- 
ations, etc., as either may be indicated, while the cure must be found 
in a restoration of the general health, for which purpose all the means 
recommended for the treatment of dyspepsia must be had recourse to. 
Jn all forms of chronic diarrhea the diet must be carefully nftended 
to; it cannot well be too bland aud simple and the whoie regimen i»» 
la all respects, the same as for dyspepsia. 



INDIGESTION. li& 



Intestinal Concretions. — There are three kinds of stony con- 
cretions found in the stomach or intestinal canal, all of which are the 
result of indigestion connected with constipation. One kind, called 
bezoar or bezoardus, is frequently found in the stomachs of ruminating 
animals, especially the goat, but very rarely in the human stomach. It 
consists of a central nucleus of gravel, straw, glass, seeds of plants, 
etc., aroun£ which a vegetable matter or animal secretion is closely 
agglutinated, having a glossy white or a bright metallic luster. These 
concretions were formerly regarded as febrifuge by physicians, and 
worn as amulets by the superstitious. 

Another kind — intestinal, calculus — more frequently found in the 
human stomach, is composed of the same earthy and sandy matters as 
are found in the bladder in calculous affections of that viscus, and are 
of various sizes, from a pea to a hen's egg. The loug-continued use 
of chalk, magnesia, etc., so generally prescribed for acidity of the 
stomach, is a frequent cause of these concretions ; hence dyspeptics 
are peculiarly liable to them. Preparations of irou, particularly the 
carbonate, when administered medicinally, have been known to accu- 
mulate in the bowels and form concretions. - 

The third kind — scybalum — consisting of indurated mucus or oily mat- 
ter mixed with hardened foeces, results from constipation, by which the 
• excrementitious matter remains too long in the cells of the colon, or 
some other part of the alimentary tract. The discharges are usually 
in the form of hard roundish balls, from the size of a pea to that of a 
walnut. The substance called ambergris, found in the larger intestines 
of the cachalot, or spermaceti-whale, is supposed to consist of the hard- 
ened foeces of the whale, and to be the result of constipation ; hente 
the more sickly the animal when harpooned, the more productive an'l 
valuable is its yield of ambergris. 

It is generally difficult to recognize these affections by the symp- 
toms, save when their character is revealed by the appearance of the 
concreted matters in the ejections or dejections. Usually, however, 
there is more or less pain or uneasiness at a particular point in the 
abdomen, and occasionally a hard, lumpy tumor, which either produces 
an external uneasiness or swelling, or may be distinctly felt on pressure 
t by the fingers. 

Treatment. — All we have to do in the way of medication is to g«t 
rid of the morbid accumulations by copious warm injections, and put 
the patient on plain, unconstipati :%, healthful fruit and farinaceous diet 

Worms.— Pathologists are not all yet agreed whether invermina- 

tion worms, or the larvae of insects inhabiting the stomach or inteis- 

II— 13 



146 PATHOLOGY AND THERAPEUTICS. 

tines — is natural or abnormal. It is not very long since a Kind of 
worm-mania prevailed in llie medical profession, by which a multitude 
of d.seases were ascribed to verminiition. Dysentery, plague, mea- 
sles, smallpox, hydrophobia, itch, syphilis, piles, cholera, and even 
toothache, have been imj'ited to various kiuds of animalcule, vermin, 
or insects. 

There is no manner of A nbt that worms are suspected, by physi- 
cians and nurses, to occasion various ailments of children much oftener 
than they really exist ; but it is equally true that they do occa ionally 
oS'ect a lodgment, and become developed in the alimentary canal, pro- 
ducing a variety of symptoms indicative of gastric and intestinal irrita- 
tion. Their origin is not so clear. In some instances it is quite ob- 
vious that the young or ova of some species of worms is taken into the 
stomach with the ingesta ; generally when drinking of stagnant or 
marshy waters, or when eating decayed or infected fruifc and vegeta- 
bles, or partially decomposed and putrescent animal food. It is also 
highly probable, at least, that the minute eggs, or ovulu, of various ani- 
malcules floating in the atmosphere, and collecting, especially in damp 
places, on the alimentary materials, get an entrance into the digestive 
cavity, and, providing they find in foul secretions, retained excrementi- 
tious matters, or impurities of any kind, a proper nest, quicken into 
kfe, grow, and become finally so strong ;:nd vigorous as to resist the 
ordinary solvent properly of the vital fluids, and the expulsive efforts 
of the unaided via medicatrix natures. This idea makes the existence 
of worms depend on a morbid condition, which I believe to be the 
fact; for I have never yet known any kind of vermin to trouble chil- 
dren who have been fed and reared healthfully. Dr. S. Cooper and 
many other medical writers of credit assert that worms are most prev- 
alent among the poor, dirty, ill-fed classes of society, and particularly in 
persons who reside in damp, marshy countries. 

A/vine worms are those which exist, and find a proper nidus in the 
stomach or alvine canal; they are mostly found in children and sickiy 
adults, producing emaciation, a swelled, hard belly, gnawing or pungent 
pain in the stomach, pale countenance, fetid breath, and irritation of 
the nostrils. These worms have been arranged into flVe varieties, viz.. 
the long round-worm, long th-fjad-worm, long tape-worm, broad tape- 
worm, nndJJukc. The first and second varieties are much more com- 
mon than the others. The latter is rarely foul. I in man, 'hough the 
most common to domestic animals. 

Anal, worms exist in or near the rectum or lower bowel. They 
excite a troublesome itching or irritation of the part, often preventing 
•sleep, and sometimes occasioning pair or faiutness in the stomach. 



INDIGESTION. 147 

The varieties found in this locality are the ascarides, called also 
thread-worm, and maw-ivorm, the beetle-grubs, and the bo/.s. The 
first variety ig most common, and is somewhat migratory, being occa- 
sionally found in the stomach and bladder. The last two kinds are 
very rare in the human animal. 

The erratic worms, which are occasionally though not frequently 
found in the ;.'imentary canal, are the hair-worm, the erratic leech, and 
the maggot. These are called erratic, because they do not find a 
proper habitation in the stomach or intestines ; they produce spasmodic 
colic, with severe gripings; and sometimes vomiting, or dejection of 
blood. The first and second varieties are chiefly found where the 
stagnant, muddy, and putrid waters of marshes, pools, and ditches is 
drank. They sometimes, when* accidentally introduced into the hu- 
'man stomach, attain an enormous size, and deviate so much from their 
ordinary shape as to be with difficulty recognized. Dr. Good says 
(Study of Medicine) : " It is highly probable, however, that they can 
only live in dyspeptic patients, or persons whose digestive powers are 
infirm ; for there are few or no animals capable of resisting the solv- 
ent power of the gastric juice when secreted in full health and vigor." 
The third variety find their way into the stomach in the condition of 
eggs or hoppers, which are deposited in various articles of food, par- 
ticularly in all strong and stale meats, cheese, bacon, etc. 

Diagnosis. — Dr. Heberden has most clearly presented the general 
train of symptoms which determine the existence of worms: "Head- 
ache, vertigo, torpor, disturbed dreams, sleep broken off' by fright, 
screaming fits, convulsions, feverishness, thirst, paliid hue, bad taste in 
the mouth, offensive breath, cough, difficult breathing, itching of the 
nostrils, pains in the stomach, nausea, squeamishness, voracity, lean- 
ness, tenesmus, itchings at the anus toward night, at length dejection 
of films and mucus. The broad -tape-worms produce the severest 
mischiefs on the body; the teretes and ascarides (round and thread- 
worms) sometimes lurk scarcely suspected, unless there is itching of 
the anus, or they are traced in the foeces." All of these symptoms, 
however, may arise from any continued irritation in the first passages ; 
hence, in forming our diagnosis, we must take the greater number of 
the above symptoms in connection with the absence of any other re- 
cognizable malady to which they can reasonably be attributed. "In all 
obscure diseases," says Swediaur, "attended with symptoms that are 
chiefly anomalous, the suspicions of the physician should be directed 
to intestinr.l worms." 

Treatment. — It is obvious that the radical cure of worms must de- 
pend upon remov'ng the morbid conditi;" which renders the aliment- 



148 PATHOLOGY AND THERAPEl TICS. 

aiy canal their habitable abode ; this implies a restoration of vigorous 
functional actions, and pure secretions; and to effect this we must 
again resort to all the medication suited to dyspepbia. Some extra 
management, however, is necessary to dislodge the intruders from their 
slimy beds, and loosen their hold upon the mucous membrane. This 
can be best accomplished by copious injections of cold water occasion- 
ally, and rigidly simple and unconcentrated food. A perfect "ver- 
mifuge" diet may be fou«d in two articles — the crusts of good, sweet 
wheat-meal bread, and gcod, ripe, uncooked apples. It is important 
that most of the food be hard, so that it be well masticated, and that it 
be eaten slowly, so that the stomach be not overloaded. Dry toasted 
brown bread is also admissible ; and cracked wheat may be used mod- 
erately by waj of variety. All slop "food is especially objectionable 
Those mothers who have pampered their little ones on fine sweet-cake 
until it has produced worms, may find it somewhat difficult lo restrict 
them to the coarse bread which will cure them. Still, they can do it, 
and should. 

Hemorrhoids. — Dr. Good limits the definition of the varieties of 
the diseases comprehended under this generic term to "livid and pain- 
ful tubercles or excrescences on the verge of the anus, usually with a 
discharge of mucus or blood." This definition excludes those swell- 
ings of the veins near the anus and within the rectum, which are 
termed hemorrhoidal varices, and which almost all persons who are 
habitually costive are more or less troubled with, evinced by pain and 
difficulty in passing the fceces, which are slightly streaked with blood. 
Dr. S. Cooper, and, indeed, nearly all medical authors, regard the va- 
rious forms as originally mere swellings of the veins. 

Description. — In their simplest state piles consist of varicose tumors 
of the anal veins, covered with a slight thickening of the mucous 
membrane of the rectum. They are first noticed in the form of 
small fleshy tubercles, generally of a brownish or pale red color and 
either situated within the anus, or descending from the rectum. They 
have rather a solid and spongy feel, and when quite external are pale, 
and more elastic and transparent; they frequently appear and disap- 
pear very rapidly. Piles often contain a central cavity, filled with flu .1 
or coagulated blood ; and" by repeated attacks of nflammation the swe'j 
ings gradually enlarge into caruncular excrescences about the verge of 
the anus, either within or without, of various shapes and forms, from 
pea-sized to fig-sized, and are frequently so painful as to prevent 
either sitting or walking. When these caruncles are hard, florid, in- 
compressible, without discharge, and innlerably sore tc the touch, the 



INDIGESTION. 140 

affection is called blind piles. When the irritation accompanying them 
induces a discharge of whitish mucus from the neighboring glands, it 
i called white piles. When the hemorrhoidal vessels, which form or 
support the growing tumors, are so distended as to burst and bleed 
freely, it is denominated bleeding piles. And when warty excres- 
cences spread about the perinaeum, or within the verge of the anus, it 
is called caruncular piles. Usually pile tumors become larger and 
firmer with every reappearance ; and when they have been strangu- 
lated for some time by the pressure of the sphincter, repeatedly 
gorged with fluids, or of very long standing, they become fixed and 
permanent in size, and acquire a greater degree of solidity; they are 
then a source of almost constant pain and trouble' from protrusion, 
inflammation, or ulceration, and often occasion a most distressing pro- 
lapsus of the lower bowel. 

Special Causes. — Among the causes assigned in medical books, we 
find " local irritation produced by indurated and retained foeces ; purga- 
tive stimulants, especially aloetic purgatives." This»may all be resolved 
into constipation, and the medicine given to cure constipation. Prob- 
ably more than half the adult population of the United States are suf- 
ferers, to a greater or less extent, from piles in some form. For eight 
or ten years past, during which time my attention has been especially 
called to this subject, I have found a great majority of invalids who 
have applied for water-treatment, whatever might have been the char- 
acter of their leading malady, to be also afflicted with this. Its special 
and alstiost exclusive cause is concentrated food, inducing constipated 
bowels ; but it is almost always greatly aggravated by the purgatives 
which have been given, by regular and irregular quacks, on account of 
the constipation. Most of the patent pills, from which newspapers 
derive so "arge a reven< and the people so many shattered constitu- 
tions, are s-irongly aloetic, and hence peculiarly calculated to inflame 
and relax the vessels of the rectum, already irritated and engorged by 
their hardened contents. Many frightful cases of external protrusion, 
or falling down of the anus, have come under my observation in the 
persons of habitual pill-takers. In some cases the bowel has prolapsed 
three and four inches. 

Dr. Good names " peculiarity of constitution" as one of the causes 
of pile tumors ; and Dr. Copland (author of a Medical Dictionary) 
"conceives that piles are most common in persons who possess a very 
strong action of the sphincter ani, and are hence habitually predis- 
posed to a spasmodic stricture of the rectum." These remarks, from 
these eminent authors I consider eminently nonsensical. Nothing but 
the false philosophy of a false system could ever induce such erudite 



150 PATHOLOGY AND THERAPEUTICS. 



nnd critical scholars to perpetrate such absurdities. According to my 
experience, nine ou; of every ten of relaxed, debilitated female.-, who 
must of necessity possess a very weak instead of very strong action of 
the sphincter, as well as of all the other muscles, are affected with pile 
tumors. 

Treatment. — Piles may be promptly relieved by local appliances ; but 
the cure depends on restoring She integrity of the digestive functions. 
The general management is essentially the same as fur dyspepsia. When 
the tumors are inllamed and painful, very frequent silz-baths, of a low 
temperature, 60° to 50°, with oft-repeated injections of a small quantity 
of cold water, should be employed, until relief is obtained ; after which 
about four to six Ounces of veiy cold water should be thrown into the 
rectum every morning previous to the expected action of the bowels. 
When the bowel is prolapsed, the patient should keep the horizontal 
position mostly, and apply the coldest wet cloths to the fundament. 
Sometimes an excessively irritable or highly inflammatory condition of 
hemorrhoidal tumors, occasions a severe and protracted diarrhea, the 
discharges occurring as often as once an hour, or every half hour, con- 
sisting mainly of small quantities of bloody mucus, or slimy matter 
tinged with blood, and accompanied with considerable tenesmus, grip- 
ing, or bearing down sensation. Such attacks usually last a week, and 
not unfrequently two or three weeks ; the patient generally, and the 
doctor sometimes, mistake the case for dysentery. Here injections 
do but little service ; the wet-sheet pack, two or three times a day, and 
the wet abdominal bandage very frequently changed, are our most ad- 
vantageous resources. 

The dietary part of the management is of first importance. In 
some few cases the mucous surface of the lower bowel is so tender 
and irritable, that almost all food seems to act as a mechanical irritant; 
the patient, however, at such times needs but very little of any kind, 
and this may be boiled rice, farina, Graham flour mush, tapioca, etc. 
But generally the unbolted and unconcentrated forms of farinaceous 
food are preferable, as in all other forms of indigestion. 

Hard warty excrescences around the anus, or scattered over the 
perinaeum, may be removed with entire safety and facility by the liga- 
ture, or knife, or clipped off with a pair of scissors. Removal by e> - 
cision and by ligature has often been practiced in the other kinds of 
hemorrhoidal tumors, but there is always danger to be apprehended 
from hemorrhage in the one case, and from sympathetic inflammation 
in the other; moreover, if all the resources of hydropathy and hygiene 
are judiciously drawn u ion, there is not the least necessity for these 
surgica operations, 



FLUXES. 151 



CHAPTER V. 



I adopt this generic term, not because it is clearly appropriate or 
distinctive* but. because it is familiar* The only species strictly per- 
taining to this genus are catarrh and dysentery, both essentially febrile 
diseases, and each consisting of a peculiar inflammation of some portion 
of the general mucus membrane; each exhibits two varieties, thus: 

/-, . , ( Common, ta .. S Acute, 

Catarrh < ' Dysentery < 

i Epidemic. C Chronic. 

Catarrh.— This is an inflammatory affection of the mucous mem- 
brane of the fauces, often extending to the frontal sinuses or bronchia, 
or both: it is attended with sneezing, obstruction of the nostril, and 
more or less mucous expectoration, or discharge from the nose. 

Symptoms. — In common catarrh — cold in the head or chest — the fever 
is slight; there is a sense of weight over the eyes, rind fullness in the 
head, and the nostrils pour forth a thick, acrimonious ichor, which ex- 
coriates the skin ; the voice is hoarse, and more or less cough attends. 
In the epidemic form — influenza — the attack is sudden, and the fever 
severe and strikingly depressive; there is great heaviness over the 
eyes, extreme languor, anxiety, and oppression at (he praecordia, with 
frequent sighing, sickness, and violent headache. The pulse is very 
frequent, and peculiarly irregular; the skin is moist, with a tendency 
to profuse sweating, but the heat of the body is seldom considerable; 
the tongue is white or yellowish, but moist; sometimes there are severe 
general or local muscular pains, and at other times erysipelatous patches 
appear in different parts of the body. The danger of this disease is 
not in proportion to the violence of the symptoms, as compared with 
all other febrile diseases, for usually the symptoms are extremely vio- 
lent for one or two days, and then as rapidly subside; great debility, 
however, frequently exists for weeks or months after convalescence is 
established. Often severe pains attack the chest, and in such cases 
physicians, regarding them as indicative of pleurisy, have endangered 
the patient's life bj' venesection. 

Special Causes. — Common catarrh is usually traceable to taking 
cold. Influenza, like Asiatic cholera, is usually epidemic, and has 
prevailed at all seasons of the year, in every state of the barometer, 
thermometer, and hydrometer. Dr. Good very cautiously imputes its 



152 PATHOLOGY AND THERAPEUTICS. 

specific cause to some "atmospheric intemperaraent ;" Dr. Weber has 
suspected "negative electricity" of the mischief; but none of the 
modern theories are any improvement on that of Hippocrates, which 
was " providential interposition ;" nor the very modest suggestion of 
Sydenham, who was rather disposed to ascribe it to '■'■some occult and 
inexplicable changes wrought ir_ the bowels of the earth itself, by 
which the atmosphere becomes contaminated with certain effluvia, 
which predisposes the bodies of men to some form or oilier of disease." 
• nfluenza is the most widely-spreading epidemic known, having some- 
times extended over all Europe and a part of America in the same 
season. 

Treatment. — This is exceedingly simple. Practically, common ca- 
tarrh may be regarded as a high fever, and influenza as a low fever 
In the former affection, the wet-sheet pack is specially indicated as the 
leading measure, repeated according to the general feverishness ; and 
in the latter, the tepid ablution, frequently repeated, and followed by 
the dry-blanket envelop when the body feels chilly after the bath, with 
the chest-wrapper, well covered when the lungs are troublesoinely 
affected, and warm hip and foot-baths when the abdominal viscera are 
disproportionately disturbed. Generally the bowels require to be moved 
by free tepid injections at the outset; and when there is considerable 
nausea and retching, the warm water emetic should be administered. 
The general regimen is the same ar, for simple fever. 

Dysentery. — Thib lisease was called bloody flux by the old authors. 
It is an inflammatory affection of the mucous coat of the larger intes- 
tines, accompanied with griping and tenesmus; the dejections are 
frequent and blood} 7 , and the feces are discharged irregularly. 

Symptoms. — In the acute variety, the abdomen is painful or tender; 
the feces are discharged with difficulty; mucous and bloody dejections 
alternate, or are variously diversified in color and consistence ; the at- 
tending febrile disturbance is considerable, and may be of the high or 
low character — the synuchus or typhoid type. 

What is called chronic dysentery is sometimes a milder and more 
disguised form of the disease, but more generally it is common diarrhea 
modified by local circumstances, or a sequel of maltreated acute dysen- 
tery. In plainer English, it is frequently a drug-disease. This remark 
need not excite surprise when the formidable array of drug-poisons 
which modern medical science has brought to bear upon this disease, 
and upon the patients' constitutions, too — calomel, corrosive subli.nate, 
sugar of lead, antimony, nitrate of silver, opium, capsicum, oil of tur- 
pentine, mineral acids, etc. — is taken into account. Chronic dysentery 



FLUXES. 153 

is attended w.th but slight fever, and that usually of the hectic type. 
Either variety may be attended with ulceration of the bowels, and puru- 
lent, sanious, or membranous evacuations, or discharges of pure, un- 
mixed blood. 

Special Causes. — Dietetic errors of all kinds are the principal pre- 
disposing, and undue exposure to cold, damp, sudden alternations of 
temperature, etc., the chief exciting causes. Bad water and marsh 
effluvia sometimes occasion the worst forms of the disease. 

Treatment. — Medical books are as discordant in relation to the 
treatment of dysentery, as they are in the case of cholera. In treating 
the disease hydropathically we must ever keep in view the character or 
tj'pe of the fever, which is in reniity as much a part of the disease as 
is the local inflammation of the colon, or other large intestines. When 
the general fever is violent, the wet-sheet pack or half-bath should be 
employed, according to the degree of heat. Moderate draughts of 
cold water should be frequently administered, and the whole abdomen 
constantly covered with the wet compress, which should be very often 
changed, until the pain, heat, tension, etc., subside. In the early stage 
one or two copious tepid injections are advisable, to clear the aliment- 
aiy canal of its irritating crudities, after which moderate cool injections 
are to be employed occasionally. Sometimes very cold or iced water 
has a more soothing effect upon the griping and tenesmus than any 
other temperature, and reference should always be had to the patient's 
feelings in regulating the temperature of the water. 

Hip-baths, the temperature low in the ratio that the general fever 
or heat of the abdomen is high, may be advantageously employed once 
in two or three hours. I have seldom found any difficulty in curing 
this complaint in children, in a very few days, by two or three daily 
tepid washings of the whole surface, the constant application of the 
wet compress to the abdomen whenever and as long as the heat was 
above the natural standard, the free use of cool or cold water as a drink, 
and one or two tepid injections at the outset. Th* diet should be: 
entire abstinence until the violence of the fever and local inflammation 
are both sensibly abated, and then as bland as possible — boiled rice, rice 
gruel, wheat-meal mush or gruel, toasted brown bread, etc. When 
ulceration takes place in the intestines, and the discharges exhibit pus, 
putrid sanies, or black, grumous, fetid blood and slime, the diet may 
be with propriety restricted, for a week or two, to rice or arrow-root. 

I have never known relapses, or "sequelae," which are so common 
and so formidable after an attack of this disease and a course of drug- 
treatment, occur in % patient who was treated hydropathically from 
first to last. 



154 



PATHOLOGY AND THERAPEUTICS. 






CHAPTER VI. 



CACHEXIES. 

Literai.lt, the term cachexia means bad habit of body, a condition 
which exists more or less in all diseases. But there is a class of dis- 
eases pre-eminently distinguished as being caused by or attended with 
universal depravity of the organization, or general derangement of all 
the bodily functions, constituting, in fact, a constitutional taint or mal- 
conformation, which may be transmitted through many generations, 
with either increasing or decreasing intensity, as the voluntary habits 
of each successive generation are more or less in conformity with 
physiological laws ; and this group of diseases may be appropriately 
considered in the present chapter, as expressed in a tabular arrange- 
ment : 



Consumption 



Marasmus 



' Tubercular. 
Catarrhal, 
Apostematous, 
Laryngeal, 
Hemorrhagic, 

w Dyspeptic. 

{Atrophy, 
Anheemia. 
Climacteric, 
Tabes. 
( Arabian 
Elephantiasis \ Italian, 

I Asturian. 



' Epistaxis, 

Haemoptysis, 

HaBmatamesis, 
Hemorrhage { n . . 
° Hematuria, 

Uterine, 

_ Anal. 

( Simple Scurvy, 

Scurvy "i Land Scurvy, 

I Sea Scurvy. 

Plethora \ f™£"' 1 ™' 
( Serous. 

Scrofula, Melanosis, 

Cancer, Catacnusis. 



Most of the above diseases, and several which 1 have thought proper 
to consider under other heads, are included in the order dysthetica, in 
Dr. Good's nosology, a term which signifies "an ill-conditioned hnbit." 

Consumption — Pulmonary Consumption— Phthisis Pulmon- 
ale. — Consumption of the lungs is the most general evidence and 
the most fetal result of the artificial and enervating habits of civilized 
society. In the city of New York, about 2000 die annually of this 
disease, and in Boston, Philadelphia Baltimore, and a majority of tho 



CACHEXIES. 156 



other cities of the, United States, the mortality from this source bears 
nearly the same dlation to the population. In most other countries 
in which civilization has made equal progress, the disease has commit- 
ted equal ravages. Dr. Young has calculated that it destroys, prema- 
turely, one fourth of the inhabitants of Europe. Females, from their 
more sedentary, indoor, and relaxing habits, are rather more liable to 
this malady than males. The period of life between puberty nnd 
middle age — fourteen to forty — is more especially favorable to the 
operation of the causes of this disease, and the greatest ratio of mor- 
tality occurs between the ages of thirty and forty. The greatest num- 
ber of deaths, in this latitude, takes place in the coldest months of the 
year. This fact, however, does not prove that the cold season is more 
conducive to the development or causation of consumption, but that 
consumptives are more liable to sink at that particular period. 

Symptoms.— Tubercular consumption is by far the most frequent 
and most intractable form ; and, indeed, some authors regard the 
existence of tubercles in the lungs as essentia] to the character of true 
phthisis. It is usually connected with a strongly-marked scrofulous 
diathesis, is more insidious in its approach, and more delusive in its 
progress than either of the other varieties. Many persons are born 
with such a malformation of the chest, and so great a predisposition to 
tubercles, that the slightest aberrations in the manner-of life suffice to 
induce that condition of engorgement, mal-assimilation, and morbid 
deposition which eventuates in general tuberculation of the pulmonary 
structures. The special symptoms are, short and tickling cough ; the 
pain in the chest is slight; there is either a sense of teuderness or 
weight experienced at the upper part of the lungs ; the breathing is ha- 
bitually short, and a full inspiration is impracticable, the attempt increasing 
the sense of weight, soreness, or aggravating the cough; the expecto- 
ration is generally scanty and small in 'uantity in the early stages, and 
in many cases it is very trifling throughout; the matter expectorated 
is a watery, whey-like sanies, sometimes tinged with blood, and as the 
disease progresses, thick, tenacious, curdy, or cheesy particles are ex- 
creted. Sometimes small, irregular stony concretions are formed by 
the deposition of earthy matters — mainly carbonate of lime — in the 
substance of the tubercles, and expectorated as the process of ulcera- 
tion releases them from their inclosures. Emaciation does not become 
strikingly apparent until the disease has made severe inroads upon the 
constitution, and not unfrequently the body maintains its ordinary full- 
ness until the greater portion of the lungs is fatally occupied by tuber- 
cular formations. In those cases attended with but trifling expectora- 
tion, there is, of course, but little ulceration ; yet generally some por- 



156 PATHOLOGY AND THERAPEUTICS. 

tions of the tubercles are ulcerating, and forming open, irregular cavi- 
ties in the substance of the lungs, while in other parts of the pulmonary 
structures, the process of tuberculation is going on. As the functional 
powers of the lungs become impaired, the pulse becomes frequent and 
feeble, the breathing grows shorter, irregular chills come on, succeeded 
by some degree of feverish heat ; and in the last stages, night sweats, 
diarrhea, swellings of the limbs, etc., denote the rapidly approaching 
fatal termination. In this form of consumption, the hope of recovery 
often attends the patient almost to the dying hour, and schemes of 
business qr pleasure, or new projects for recovery, occupy his thoughts 
until within a few days or hours of death. 

There has been much controversy among medical theorists whether 
tubercles are the product of inflammatory action, or of irritative action, 
or of an action to which some other technical term should be applied. 
The discussion is entirely unprofitable. It is enough to know that the 
general condition of the body i3 one of debility; that the local condition 
of the part diseased is one of engorgement, and its secretions changed 
from a healthy to a morbid character. It is also a disputed point 
whether tubercles in the lungs are curable in any caee, some eminent 
authors taking the position of their absolute and unconditional fatality, 
while others, equally respectable as practitioners and pathologists, can- 
tend that cures have resulted in a few instances. 

Dr. Good, in allusion to a remark of Dr. Woolcombe, that 55,000 
victims annually die of consumption in Great Britain, makes the follow 
ing very singular observation : "During the last half-century, it is said 
to have been considerably on the increase ; but this is perhaps chiefly 
owing to the greater number of infants of delicate health who are 
saved from an early grave by the introduction of a better system of 
nursing than was formerly practiced, yet who only escape from a dis- 
ease of infant life to fall before one of adolescence or adult years. 
And, for the same reason, savages rarely suffer from consumption, as 
they only rear a healthy race, and lose the sickly soon after birth." I 
think a better explanation can be found in another way. Much of the 
increasing mortality is justly attributable, in my opinion, to the intro- 
duction of a worst system of nursing infants than formerly prevailed, 
to wit: close rooms, hot slops, tight clothing, nick-nack food, apothecary 
drugs, etc., by which the bodies of the infants become sickly, stunted, 
feeble, and susceptible before they emerge from their cradles. The 
reason that the savages seldom have consumption is because they are 
comparatively exempt from the peculiar debilitating customs of our 
"better system." The statement that they lose nil their sickly children 
is wholly gratuitous, 



CACHEXIES. 157 



In the catarrhal form the cough is frequent and violent, with a 
copious expectoration of a thin muco-purulent matter, rather mixed 
with blood, but generally offensive to the smell. There is considerable 
soreness of the chest, and transient pains shifting from side to side, 
it comes on after repeated colds, or a protracted catarrhal affection. 

The apostematous variety is known by a dry cough, which returns 
fitfully; fixed, circumscribed, obtuse pain in the chest, which is some- 
times throbbing or pulsatory ; the patient experiences great difficulty 
in lying on one side. The cough at length terminates in a sudden and 
copious expectoration of purulent matter, which sometimes threatens 
suffocation. These symptoms are immediately owing to the formation 
of an aposteme or abscess in the lungs. When the collection of matter 
is considerable, the patient often experiences severe rigors or chills, 
and manifests a high degree of irritative fever. After the discharge 
of the matter, the patient is sometimes permanently relieved ; but 
usually the relief is temporary, and all the symptoms recur repeatedly 
at longer or shorter intervals, as new abscesses form and discharge 
their contents. In some few instances no expectoration takes place, 
the patient dying before the abscess breaks. 

Laryngeal phthisis is that modification of the disease in which ul- 
ceration commences in the larynx before any extensive morbid altera- 
tions have occurred in the lungs. It is distinguished by excessive irri- 
tation and tickling in the larynx, with a cough dry and husky at first, 
but soon attended with a slight discharge of purulent mucus, frequently 
streaked with blood ; there is also remarkable hoarseness, which occa- 
sionally goes and returns without any assignable cause, and a sense of 
soreness or tenderness about the upper part of the throat ; often there 
is some degree of actual hemorrhage from the diseased part. 

All these symptoms may occur in the last stage, or near the fatal 
termination of either of the .other forms of consumption, more espe- 
cially the tubercular ; and also in the worst cases of bronchitis ; they 
can, therefore, only be properly regarded as a distinct variety of phthi- 
sis when they take the lead in the morbid manifestations. When tho 
ulceration of the larynx, instead of preceding disorganization in the 
lungs, comes on after ulceration in the lungs has long existed, the pa- 
tient complains more particularly of a sore, oppressive sensation in the 
throat, as if some foreign mass were lodged in the larynx ; and this 
sensation is generally accompanied by more or less difficulty of swal- 
lowing ; it is, too, usually accompanied with a peculiar hoarseness, or, 
rather, roughness in the voice. In most cases it is a fatal omen, occur- 
ring only a few days, or at most a few weeks, before death. 

The hemorrhagic variety is. characterized by repeated attacks of 
vi 



158 PATHOLOGY AND THERAPEUTICS. 

hemoptysis, or bleeding at the lungs. The coughing or expectoration 
of a large quantity of blood, may indeed be, and usually Ts, an acci- 
dental occurrence in all the other forms of the disease, especially the 
tubercular and the dyspeptic varieties ; nevertheless, it sometimes takes 
place without evidences of any considerable organic change either in the 
lungs or digestive organs, and recurs with such frequency and violence 
ns to exhaust the patient, producing all the train of constitutional symp- 
toms which marks the progress of the other varieties of consumption. 
It is intimately connected with the next variety — dyspeptic phthisis — 
and usually depends immediately on an excessively engorged condition 
and relaxation of the pulmonary vessels, this condition being chiefly 
owing to a shriveled, bloodless state of the superficial capillaries, or to 
an enlarged liver, or, which is more common still, to both of these cir- 
cumstances combined. 

Dyspeptic phthisis is that form of pulmonary consumption which is 
preceded by protracted disease of the digestive organs; the lungs are 
affected sympathetically, or, rather, the morbid condition is extended 
from the abdominal viscera to the lungs ; the liver being usually the 
organ most concerned in the primary malady. This variety of con- 
sumption is more common than is generally supposed, constituting, in 
fact, a majority of the cases we meet with. It is seldom correctly 
diagnosticated, from the fact that, when the. lungs become promi- 
nently the seat of the morbid phenomena, the prior evidences of 
digestive derangement, or disease of the liver, are overlooked ; very 
often the latter are so obscure as to be wholly disregarded, unless 
the physician discovers their relation to the affected lungs by a careful 
investigation of the history of the patient, from the first appearance 
of ill-health. Dr. Wilson Phillip says that drunkards, whose digest- 
ive powers have been broken down by ardent spirits, frequently fall a 
sacrifice to this disease ; and he regards those who have suffered se- 
vere attacks of dyspepsia, and what are called bilious complaints, as 
peculiarly liable to dyspeptic consumption. 

Diagnosis. — As it is only in the incipient stage of all forms of con- 
sumption that we can have any reasonable assurance of effecting a 
radical cure, it becomes exceedingly important to detect the malady 
before it has made irremediable advances. It is impossible to give a 
list of symptoms which may be relied upon ns pathognomonic. When- 
ever the patient experiences habitual cough, be it ever so slight, and 
habitual expectoration, of whatever character, with shortness of breath, 
a sense of pain, fullness, weight, or uneasine?s in the chest, with an 
increasing feeling of general languor or debil'ty, the case is probably 
consumption, and should thencefo-fh receive the closest scrutiny. If 



CACHEXIES. 169 



these symptoms hnve been preceded by dyspeptic indications, or evi- 
dences of disordered or torpid liver, the danger is greater; and if the 
constitution is manifestly scrofulous, still greater apprehension may be 
entertained. In the early stage of the dyspeptic variety, the cough 
and expectoration occm chiefly in the morning, and are hardly noticed 
during the remainder of the day; the expectoration consists of a small 
quantity of tenacious mucus or muco-purulent matter, generally dis- 
colored in the morning by a carbonaceous, dark-colored stain, as though 
charcoal dust had been diffused through it. 

The early symptoms in all forms of consumption are obscure and 
insidious; find those which attend its progress and mark its several 
stages are subject to very great diversity. But the general progress 
of the symptoms may be enumerated as follows: The patient first be- 
comes sensible of unusual languor, and breathes with less than usual 
freedom ; his respirations are shorter in duration and more frequent 
in number. He coughs occasionally, but does not complain of its 
being troublesome, and he very rarely expectorates when coughing. 
Some degree of pain, soreness, weight, or uneasiness, will be at this 
time experienced in some part of the chest whenever the patient 
makes a deep and prolonged inspiration. As these symptoms increase, 
the pulse becomes more frequent and weaker, particularly in the after 
part of the day. After the disease has made a little further progress, 
there is feverish feeling or hectic flush toward evening, a tendency to 
undue perspiration during the night, and either the sleep is disturbed 
by fits of coughing during the night, or a considerable parox}-sm of 
coughing takes place early in the morning, leaving the patient with a 
greater feeling of feebleness and relaxation. This assemblage of symp- 
toms may be considered as constituting the first stage. 

In what may be regarded as the second stage, in which the disease 
is evidently established and generally hopeless, the cough increases in 
frequency, and, from being dry, is accompanied with a purulent mucus, 
varying from a watery whey-like matter occasionally tinged with blood, 
to an expectoration of genuine pus, which may be variously colored — 
livid, deep black, light brown, light green, bright or dark yellow, hard 
and lumpy, or soft and shredy, flattened or round, fetid or odorless. 
In many cases of the tubercular form it is very scanty, while in a ma- 
jority of the catarrhal it is extremely copious. The uneasiness in the 
chest is now felt more constantly, and the sense of weight has become 
permanent; hectic fever is fully developed, and the breathing is often 
accompanied by a sound somewhat like the ticking of a watch. The 
strength fails rapidly, the body emaciates, the pulse beats more fre- 
quently and feebly, generally ranging from 100 to 130 ; yet in some 



160 PATHOLG.; Y AND THERAPEUTICS. 

instances of the dyspeptic variety I bfive known the pulse to preserve 
the slow, languid motion characteristic of that form of digestive de- 
rangement in which torpor of the liver is a prominent condition, until 
the last. The teeth usually increase in transparency, and the eye man- 
ifests an unnatural brilliancy, the sclerotic coat becoming of a pearly 
white. The fingers -are shrunk, except at the joints, which become 
prominent; thu tjails are bent for want of support; the nose is sharp; 
the eyes Bunkon; the countenance wears a peculiar but mortal smile; 
the whole body is shriveled ; the spine projects, instead of sinking, 
from the decay of the muscles ; and the shoulder-blades stand out like 
the wings of birds. 

The third stage is attended with diarrhea, apthous or ulcerated 
throat, difficulty of swallowing, dropsical swellings in different parts of 
the body, and various other symptoms indicative of the final exhaustion 
of the powers of life. 

Although extreme emaciatioi. usually occurs before death, yet in a 
few cases, particularly in the apostematous variety — which is the form 
most frequently designated as the quick or galloping consumption — 
the progress of the local inflammation is so rapid, that the extensive 
disorganization of the pulmonary structure produces a fatal result be- 
fore the body is greatly attenuated. In a few instances recoveries 
have happened after extensive vomica, or abscesses, have been formed 
in the substance of the lungs ; and a very few examples are recorded 
in which the patient has survived the entire destruction of one lung. 

Pathological Appearances. — Dissections, which do not prove the 
nature but the effects of disease, show, in almost all cases, an indurated 
and ulcerated condition of the lungs. Tubercles are formed indiscrim- 
inately in all parts of the cellular texture of the lungs, but more fre- 
quently and abundantly at its upper and posterior parts. They exhibit 
every diversity of size ; are generally whitish and opake, like small 
absorbent glands, but sometimes semi-transparent, like cartilage, with 
black dots in their substance. They often augment by degrees till 
they attain half an inch in diameter ; but usually, when about as large 
as peas, they begin to soften in the center, and finally open by one or 
more small apertures into the neighboring bronchia?, or remain for a 
longer time closed, and constitute small abscesses, filled with a curdy, 
half-formed pus. In some cases large abscesses are formed, without 
any trace of tubercles ; in a few cases the lungs appear hardened, he- 
patized, or shriveled into a leathery appearance ; and occasionally tho 
whole cellular substance is occupied by tubercles, with little appearance 
of excavations or open ulcers. 

Physiological Signs- — Much attention has. of late years, been be- 



CACHEXIES. 161 



stowed upon percussion and auscultation as means for ascertaining the 
exact morbid conditions or structural derangements of the thoracic 
viscera and the steiliescope, invented by Laennec, has come into very- 
general use, as a convenient acoustic instrument for the purpose of 
determining, with greater precision, the abnormal changes which take 
place in the lungs. There is no doubt that, by much experience, the 
practitioner can, in many cases, decide with much greater accuracy as 
'to the exact point of the lungs most diseased, and, possibly, as to the 
extent in which the disease has involved the lungs in disorganization, 
with the aid afforded by a careful stethescopic examination ; yet, on 
the whole, I regard the instrument as of very little practical value. So 
far as the prospect of cure and the proper course of medication are 
concerned, the intelligent physician can derive no advantage from the 
stethescope ; and even experienced practitioners are about as liable to 
diagnosticate erroneously with as without its assistance. I can name 
at least one person in the city of New York whose lungs Mere pro- 
nounced incurably tuberculated by an- experienced professor of stethos- 
copy, who is now in the enjoyment of excellent health. 

Special Considerations. — Consumption has been regarded as conta- 
gious by some. There is no question that all diseases have a tendency 
to propagate their kind — like causes like — yet this disense is not more 
chargeable with "personal communicability" than a majority of others. 
It may, indeed — and I have known such instances — be 'acquired by a 
vigorous, healthy person, who has no hereditary predisposition, by a 
ong and intimate intercourse with, or attendance upon, a patient who 
has declined under it; as, for example, a husband or wife, devoting 
himself or herself assiduously to the care of a bosom companion 
through all the stages of the malady, occupying the same room, sleep- 
ing in the same bed, and personally performing all the acts of kindness 
and duty required by the patient's condition, may in time become simi- 
larly affected. It has been remarked by most authors that any sud- 
denly suppressed evacuation or accustomed discharge, is peculiarly lia- 
ble, especially when a predisposition exists, to induce consumption. I 
think, however, all the danger from this source could be obviated by a 
proper attention to the general health. A suppression of the menstrual 
secretion in females is supposed peculiarly to conduce to the formation 
of a consumptive diathesis ; but more generally the suppression follows 
as a consequence of prior disease of the lungs. Pregnancy often arrests 
the progress of the disease, even when far advanced ; but it recurs in 
all its force soon after the function of gestation is completed. 

Treatment. — It is the common consent of the medical world that 
consumption is incurable, especially in all stages afte ' the first ; and 



102 PATHOLOGY AXD THERAPEUTICS. 



those few examples of cures recorded in medical works have confess- 
edly recoveied "spontaneously," or by "the efforts of nature," at all 
events, witnout I he benefits of drug-medication. Under water' treatment 
some cures of Apparently hopeless cases have been made ; the majority, 
however, who have thus far sought the aid of the new system have 
deferred it too long, yet, although they have necessarily failed of being 
radically cured, they have, in nearly all instances, been great ly bene- 
fitted, while in many cases life has been extended for several years. 

Practically, we are to regard the affection of the lungs as a local ex- 
pression of a general disease ; hence the constitutional management is 
of incomparably more importance than the topical. Every measure 
which tends to invigorate the general system, and every appliance 
which will conduce to a more free expansion of the lungs, and assist in 
relieving their congested condition by diffusing the accumulated blood 
over the surface, must be perseveringly employed ; while, negatively, 
all sources of irritat.on and debility must be sedulously avoided. In- 
stead of bundling up in flannels, and sitting down by a hot stove, or 
lounging in a warm room, the patient must dress as lightly as possible 
without actual discomfort; he must take as much out-door exercise as 
his strength will permit, and spend as much of his time in the open 
air — in walking, riding, sailing, etc. — as possible, without exhausting 
fatigue. Horseback exercise, I think, is not advisable after the disease 
h fairly formed, the other kinds being altogether preferable. High 
mountainous regions are certainly preferable to low lands for consump- 
tives, the air being not only more dense but more pure. A residence 
inland, and a voyage at sea, are both preferable to a residence on the 
sea-shore, in a case of confirmed consumption, for the reason that 
there is less uniformity of climate and temperature in the latter locality 
than in either of the other situations. A removal to warmer and nnre 
equable climates — Florida, Cuba, Madeira, etc. — is not necessary to 
the cure of the malady". In some cases, however, it seems to stay its 
progress, while in others the change hurries it on rapidly to a fatal termi- 
nation. Medical authors wholly fail to account for these diverse results. 
The explanation is probably this: Of those who go to the South, or to 
more genial latitudes, some are affected with primary disease of the 
liver and digestive organs, the lungs being secondarily or sympatheti- 
cally diseased ; while in others the lungs were the organs primarily 
affected with local disease. The former will decline with greatly 
accelerated speed on going to 'a much warmer latitude, but the latter 
will generally experience a temporary alleviation of symptoms. 

A great variety of muscular or g3'mnastic exercises can be employed 
to advantage in expanding the chest Striking the elbows or backs of 



CACHEXIES. 1G3 



llie hands together behind the back; making gentle circular motions 
with the hands while both arms lire extended laterally from the body; 
striking th» hands out laterally alternately, etc., are useful methods. 
The body must always be kept in the erect posture whether exercising 
or Mt rest, sleeping or waking. One of the very best respiratory exer- 
cises is that of taking slow, deep, full inspirations, holding the breath 
ns long as convenient when the lungs are fully inflated, and then expir- 
ing very slowly ; this may be practiced a few minutes at. a time, and 
repeated many times a day. Silver tubes have been constructed to 
assist the consumptive in expanding the lungs in this way, and in many 
cases very great benefit has been derived from them ; still they are no 
better than a common goose-quill, nor have either any advantage over 
the practice of respiring through the nose in the same slow, regular 
manner. Let it be remembered, that in all kinds of exercises care 
must be taken not to greatly disturb the breathing or accelerate the 
pulse. Within this limitation they should be as frequent and active as 
possible. Dumb-bells afford a good exercise, but they must be handled 
gently, and not be very heavy. The play of graces is also excellent. 

With regard to diet, no disease, not even dyspepsia, requires a more 
rigidly plain and abstemious course. The general plan of dieting is the 
same as in cases of dyspepsia. But the irritable state of the general 
system, coupled with the inflammatory condition of the. lungs, causes 
the most trifling disturbance in the digestive organs to result in a much 
more serious injury to the lungs. I have repeatedly seen all the 
Byinptoras severely aggravated, the expectoration entirely changed for 
the worse in character, the cough greatly intensified, and all the ad- 
vantage gained by a month's faithful treatment lost by a single injudi- 
cious meal. Consumptives labor under one disadvantage which dyspep- 
tics do not in the matter of dieting. The latter feel whatever hurts 
them in the stomach, and hence in their feelings have a better guide 
to direct them in the choice of food, or rather in respect to what may^ 
be profitably abstained from. The former have the sensibility and irri- 
tability more concentrated upon the lungs, and frequently have no other 
evidence of what agrees or disagrees with the stomach than the better 
or worse character of the pulmonary symptoms. Experience, there- •'• 
fore, is, with the consumptive, a more blind guide than with the dys- 
peptic. Judgment must reign supreme here, and appetite and morbid 
sensibility obey. 

For these reasons the diet may be, and, on the whole, should be, more 
bland, watery, and innutritions than is tolerated in the majority of cases 
of dyspepsia. I believe nearly every case will do better by entirely 
abandoning all animal food, save milk, and even this should be used as 



164 PATHOLOGY AND THERAPEUTICS., 

a seasoning rather than as a substantial part of the meal. Coarse bread, 
wheaten grits, the mildest vegetables and best fruits, constitute the best 
articles of food, and a sufficient variety, as far as the question of recov- 
ery is concerned ;. and even this simplicity will avail nothing unless 
strict moderation in quantity is at all times observed. In many cases, 
and in all in which I have advised the experiment, the patient has 
been evidently advantaged by taking a very light breakfast, a moderate 
dinner, and no supper at all. The oppressed lungs require all the 
room and all the quiet possible to obtain during sleep ; and a trifling 
load or irritation in the stomach will often produce a restless night, and 
a more engorged condition of the lungs. 

In all cases except those attended with considerable emaciation and 
severe dyspeptic symptoms, rather free water-drinking is advisable ; 
not, however, to the extent of sensibly oppressing the stomach. From 
five to ten tumblers can usually be taken daily to advantage. 

In regulating the bathing processes, we must keep in view a three- 
fold condition — general debility, feverish excitement, and local inflam- 
mation. Consumptives generally bear cold bathing well, but the 
baths should seldom be very long continued. When the superficial 
heat is not materially deficient, nor the hands and feet inclined to much 
coldness, the cold wet-sheet pack for an hour, followed by the tepid 
shallow bath, for five minutes; the half-bath at 72°, five to ten minutes, 
and the hip-bath at about 65°, fifteen minutes, with the constant em- 
ployment of the chest-wrapper, constitute a plan of bathing which, 
with such modifications as will be suggested by individual circumstances, 
is adapted to the majority of cases. The walking foot-bath I have 
known peculiarly serviceable in several cases. The douche, of mod- 
erate force, is a useful adjunct in the early stage of the tubercular 
variety; and in the incipient stage of all forms, I have observed mani- 
fest relief of the local symptoms by the spray or fountain applied to 
jthe chest daily, or every other day. In the latter stages, when the 
patient is troubled with rigors or chills, the dry pack, during the cold 
stage, will usually shorten the duration of the chills, and mitigate their 
severity. Night sweats may be checked or palliated by the rubbing 
wet-sheet at bed-time, if the patient is able to bear it, if not, by spong- 
ing the surface with tepid water. 

When extensive ulceration or tuberculatum exists in the luno-s, the 
patient will be extremely sensitive to cold, and the temperature of the 
water should be milder ; care should be taken, under these circum- 
stances, to avoid any bath which occasions much of a shock to the 
system. 

For the benefit of such consumptives as are compelled to do the 



CACHEXIES. 105 



best they can with home-treatment, it may be stated that very little 
bathing is absolutely essential, if the patient will attend strictly to all the 
other resources of hygiene. One or two sponge-baths or towel-washings 
daily, and one or two site-baths, with the employment of the chest- 
wrapper or abdominal girdle, as the local symptoms are more prominent 
in the respiratory or digestive organs, al! of which processes the patient 
can manage with very little assistance, will answer all remedial pur- 
poses, provided the patient keeps in the open air as much as possible, 
takes almost constant but not violent exercises, according to his strength, 
and lives on the smallest quantity of coarse, bland food, which will 
range above starvation. 

I cannot conclude this topic without a paragraph of animadversion 
upon the popular allopathic method of doctoring consumptives. I have 
known so many scores of persons killed outright, so many cases of incip- 
ient converted into confirmed consumption, and so many confirmed con- 
sumptives hurried out of the world, by drug-medication, that I cannot 
speak or write on the subject, except with language of earnest denun- 
ciation against the senseless and murderous practice of reducing and 
poisoning the systems of those unfortunate invalids, whose vital powers 
are wasting fast enough without being aided by " medical science." Thf» 
ordinary treatment may'be resolved, substantially, into opium, bleeding 
antimony, blisters, and expectorants. Each article and each process, I 
affirm, is individually injurious, and all are collectively pernicious. The 
opium lessens the effort at coughing, by which the lungs endeavor to free 
themselves of a morbid secretion, but aggravates the actual diseased 
condition of the lungs. The bleeding lessens the patient's sensibility 
— feeling — for a brief period, and renders him less conscious of his 
disease ; but it is at the expense of his vitality. The antimony lessens 
the febrile excitement, and diminishes the force of the circulation by 
deadening the nervous influence, and destroying the ability of the 
muscular fibres to act at all. The blisters abate the pain and soreness 
in the lungs by paralyzing the natural sensibility, or overwhelming the 
lesser with a greater pain; but they render the intercostal muscles sore 
and sensitive, make a free expansion of the lungs more painful and 
more difficult, and thus tend to fasten the disease irrecoverably upon 
the system. Expectorants, which are given to facilitate the excretion 
from the bronchial ramifications, make the patient raise easy by in- 
creasing the quantity to be raised ; and as the secretion of mucus, or 
pus, is already morbid and in excess, there can be no possible ultimate 
advantage in increasing it. I know very well the theories — and they 
are quite "too numerous to mention" — upon which such practice is 
advocated and defended ; but they are as absm d and irrational as tha 



1GG PATHOLOGY AND THERAPEUTICS. 

practice is unsuccessful and death-dealing. Of the lengthy cata/bgue 
of specifics which have had and still have a reputation in the medical 
world for curing consumption — digitalis, cod-liver oil, etc. — I need not 
speak. If the fact that all the patients who are cured by them soon 
go to their graves, is not a sufficient commentary, and if the forty or 
fifty deaths in the city of New York returned weekly to the inspector's 
office by the physicians under the head of consumption, do not suffi- 
ciently attest the fallacy and falsity of the popular theory and practice, 
as far as this malady is concerned, no explanation that I could offer 
would be of any avail. 

Marasmus. — A morbid condition, of which general emaciation of 
the body, with debility, without local inflammation or other disproportion- 
ate affection of any particular organ orviscus, has long been recognized 
by physicians under the generic term marasmus. " Leanness," says 
Dr. Good, "is not necessarily a disease ; for many persons who are 
peculiarly lean are peculiarly healthy." It is only when increasing 
debility accompanies gradual emaciation that the extenuation of the 
system is to be regarded as abnormal. The proximate condition upon 
which all the varieties of marasmus depends, is bloodlessness. The 
manufacture and supply of nutrient material is not equal t» the waste, 
and this implies a primary fault in the digestive or assimilating functions, 
or obstruction in the capillaries. 

Symptoms. — In the first variety — atrophy — the complexion is pale, 
often squalid; skin dry and wrinkled ; muscles shrunk and inelastic; 
the appetite is feeble or capricious ; there is little or no fever. With 
infants or young children the above symptoms are preceded by flaccid- 
ity of the. flesh, bloated prominence of the abdomen, irregularity of 
the bowels, and pendulousness of the lower limbs. To these symptoms 
succeed drowsiness and languor, chilliness in the morning, flushed 
cheeks, restlessness and general feverishness toward evening; the 
urine is scanty, the foeces dark, green, or pitchy, and highly offensive; 
the skin is hot, dry, and extremely irritable, and the child is constantly 
picking the nose, lips, corners of the eyes, fingers, and anus. This 
form of marasmus has been variously termed, in medical books : in- 
fuutiie remittent fever, gastric remittent, infantile hectic, worm fever, 
mesenteric fever, stomach fever, low fever of children, etc. 

In the second variety — anheemia, aneemia, exsanguinity — the whole 
surface, atid particularly the face and lips, are ghastly pale; pulse fre- 
quent and feeble; dejections from the bowels irregular, black, and 
fetid; appetite greatly impaired; emaciation and debility extreme. 

The thirc" variety — alvnacteric — has been called, very incorrectly, 



CACHEXIES. 107 



decay of nature. The term adopted is derived from the Greek phys- 
iologists, who divided the period of life into five epochs or climaxes, at 
each of which they supposed the body was peculiarly liable to some 
remarkable and sudden alteration for better or worse. It is character- 
ized by general decline of bulk and strength, with occasional renova- 
tion, subsequent to the middle period of life, without any manifest local 
disease. 

The fourth variety — tabes — has been known by the simple appella- 
tion, decline ; it is distinguished from atrophy by the presence of hec- 
tic fever. It appears at any age "f life, aud is also characterized by 
the accompaniment of depresset. spirits. It is the consequence of 
some lurking poison in the system, generally of a scrofulous or syphi- 
litic character, or of excess or intemperance ir the exercise of the 
animal propensities, or indulgence of the passions When occurring 
from undue indulgence in libidinous pleasures, it has been cailed tabes 
dorsalis, from the great weakness which is experienced in the back 
and loins. The habit of self-pollution often induces this malady in boys 
and girls, and sometimes even before the age of puberty. 

Special Causes. — Scarcity of food ; improper aliment, as baker's 
sweet-cake, and distillery milk; profuse evacuations; scrofulous, scor- 
butic, or syphilitic taint ; mineral drugs, as mercury, antimony, nitre, 
and potash; acrid narcotics and debilitating sedatives, as opium, alcohol, 
tobacco, digitalis, iodine, hydriodate of potassa; antiphlogistic medicines, 
as salts, vinegar, colchicum ; irritant drugs, as aloes, pr iparations of 
iron, nitrate of silver, arsenic; cold, damp, and impure air, as found in 
low basements, dark cellars, subterranean tenements, rear buildings; 
depressing mental influences, as the loss of friends, or reverses of for- 
tune ; violent passions ; venereal excesses. 

Treatment In eveiy case of genuine marasmus, the grand morbid 

condition is deficient circulation in the capillary system. Whether the 
nutritive functions are abnormally torpid, or the excretory organs pre- 
ternaturally active, or whether the functions of supply and waste nre 
both morbidly affected, the single in lication of cure is the same — to 
augment capJIary circulation. Of course, all the causes which are 
operating to produce or continue the malady are to be sought out and 
removed or counteracted, and all the resources of hygiene are to be 
applied to the general invigoration of all the organic functions; but the 
bathing appliances are few and simple. The dripping wet-sheet or 
towel wash, and the half or shallow- bath daily, followed by as much 
friction or rubbing over the dry sheet as the patient can well bear, are 
the best water-processes, and in most cases all that are necessary. The 
teniDerature is a matter of considerable importance. It should be us 



168 PATHOLOGY AND THERAPEUTICS. 

cold as is consistent with prompt reaction ; the proper rule, as in all 
cases or" feeble circulation, is to begin with water of a comfortable 
temperature, say about 80°, and very gradually reduce it as the pa- 
tient becomes accustomed to the impressions. For very feeble patients 
one bath daily may be sufficient to commence with ; and such should 
Jake frequent exercise in the open air, by riding in a carriage if unable 
to walk. With regard to water-drinking and diet, the rules often 
heretofore intimated are to he observed. In most cases the strict or 
dry diet is the most desirable. 

The allopathic treatment consists mainly of stimulating food, as flesh- 
rneat, soups, broths, etc., and irritating drugs, particularly the different 
preparations of iron ; and although almost every author of that school 
coincides in this plan of treatment as the only one to be relied upon, 
yet almost every case on record so treated resulted in death ! The 
form of this disease called anhcemia has lately attracted considerable 
attention in the medical profession because of its frequent occurrence 
in women soon after childbirth. One of the allopathic journals, a few 
months ago, related the particulars of six cases, all of which went 
down to death rapidly under the "tonic" and "supporting" system of 
iron and wine; and concluded the sad story of mortality with an "able 
argument" in favor of the same treatment as the only hope of the 
patient ! 

Elephantiasis. — This affection, called in English elephant skin, 
consists of a thick, livid, rugose, tuberculated, and insensible state of 
the skin. It is attended with great debility, and a variety of morbid 
symptoms, the sum total of which evince a general depravation of all 
the fluids of the body. Among the most prominent of these are re- 
marked, highly offensive perspiration, and fierce, staring eyes. 

The first variety— Arabian— black leprosy — is hereditary in Arabia 
and India, and is in those countries regarded as contagious. It is also 
known in the high northern latitudes of Norway, and is very prevalent 
in Iceland. The tubercles are chiefly confined to the face and joints ; 
the voice, is hoarse and nasal; the hair, except on the head, falls off ; 
the nose is swelled and scabrous; the lips tumid; the nostrils preter- 
naturally dilated; the lobes of the ears are enlarged and thickened, 
and beset with tubercles ; the external sensibility is so obtunded that 
pinching or puncturing tha skin occasions no pain. At length the 
tubercles crack and ulcerate ; ulcerations also appear in the throat and 
nostrils; the breath becomes intolerably fetid ; the nose falls off; the 
palate is destroyed; the fingers and toes become gangrenous, and drop 
off one after another. 



CACHEXIES. 169 



The Italian variety is found chiefly among the Milanese and Vene- 
tian peasantry, who live in wretched hovels, breathe foul air, and eat 
gross and unwholesome food. The disease comes on with languor, 
listlessness, gloom, weakness and stupor in the lower extremities, ver- 
tigo, mental confusion, etc. These symptoms, which usually occur in 
the spring, - are followed, as the warm weather increases, with burning 
and itching over the whole surface, except that of the head, and these 
are succeeded by an eruption of rosy papulte, scattered generally over 
the skin, and terminating in tubercles of a shining red color. During 
the summer the tubercles desquamate, and the skin finally recovers its 
natural color. In the winter the patient recovers some degree of 
strength, but the symptoms reappear with increased violence with the 
return of spring, and again subside on the recurrence of cold weather, 
and so on for several years in succession. In the end, delirium, furious 
mania, or stupid melancholy, diarrhea, and dropsy come on, and not 
unfrequently the miserable victim terminates his sufferings by the act 
of suicide. 

The variety called Asturian, is the Asturian leprosy of Sauvages, 
and some other nosologists, and the mal de la rosa of the Spaniards. 
It is found among those who inhabit filthy tenements, crowded, unveu- 
tilated rooms, swampy valleys, etc. It differs from the preceding variety 
in attacking the head as well as the other parts of the body, the tuber- 
cles are peculiarly painful, highly fetid, more deeply furrowed with 
cracks, and more disgusting to the sight. 

Treatment. — Cleanliness, in the broadest acceptation of the word, 
comprises the whole remedial course. Frequent cool or tepid bathing 
or washing of the whole surface, copious water-drinking, and a dietary 
restricted to plain vegetables, fruits, and farinacea, are all the details 
which need occupy these pages. 

Hemorrhage. — Occasional or accidental hemorrnages occur in a 
great variety of diseases, not connected with any general taint or dep- 
ravation of the organism. But it is only when bleeding results from an 
impaired or partially putrescent quality of the blood itself, or from a 
debility and relaxation of the coats of its containing vessels, or from 
both of these conditions together, constituting the hemorrhagic diathesis, 
that the affection properly pertains to the genus before us. A flow of 
blood from the nose, lungs, stomach, bladder, uterus, or anus, may 
result from local congestion or incidental plethora — constituting the 
enlonic hemorrhages of Dr. Good — and either of these conditions may 
depend on temporary or occasional causes ; tne group of diseases, 
therefore, included in the present genus, comprises only the atonic 
11-15 



170 PATHOLOG-Y AND Till .\ I . Cl'ICb. 

hemorrhages of authors. Wi.en the hemorrhagic diathesis lias become 
established, nos* bietding is most common during the periods of youth 
and of senescence; bleed. ng from the lungs occurs most frequently 
between the ages of fifteen and thirty-five ; and in more advanced life 
the tendency is to more frequent hemorrhages from the abdominal 
and pelvic organs. 

In the first variety — epistaxis — nose- bleeding — the quantity of bloou 
lost is. in some instances, enormous. Examples are recorded of its 
continuance for several days, and even weeks, of the quantity of blood 
discharged amounting to ten, twenty, and even forty pounds. 

In tlie second variety — hcemoptijsis — spitting of blood — bleeding 
from the lungs — it is often difficult to determine from whence the 
blood issues; whether from the fauces, posterior cavities of the nos- 
trils, the lungs, or the stomach. In haemoptysis the blood is thrown 
up chiefly by coughing ; the blood is of a florid, arterial hue ; there is 
a sense of tickling about the fauces ; moreover, it is usually preceded 
by flushed cheeks, more or less pain in the chest, with some degree 
of dyspnoea. Sometimes, however, there are no precursive symp- 
toms, and the blood is rather hawked or spit up intermixed more or 
less with saliva, and is of a darker color ; but in this case an irritative 
cough ensues, and the blood is mingled with a frothy mucus. When 
the spitting of blood is from the cavities of the nostrils, it will cease on 
lying procumbent, or bending the head forward, and will then probably 
flow from the nose. When it proceeds from the fauces, the fact can 
generally be ascertained by ocular inspection. 

In htsmatemesis — vomiting of blood — bleeding from the stomach — ■ 
the blood is of a dark color, is thrown up by vomiting, and is usually 
intermixed with food ; the discharge is preceded by tensive pain about 
the stomach, and accompanied with anx-iery and faintness. In some 
cases the blood is discharged from the bowels at the same time. 

In hematuria — bloody urine — the hemorrhage is from the bladder 
or kidneys, and the blood is discharged at the urethra, sometimes in- 
termixed with urine. The evacuation is preceded by pain in the pel- 
vic region, and accompanied with faintness. 

Uterine hemorrhage is called menorrhagia in most medical books, 
and described as an excess of the menstrual discharge. This is a mis- 
take. It is not a profuse catamenial secretion, but an actual bleeding 
from the uterine vessels. In fact, it is always attended with a real 
deficiency of the menstrual flux. It sometimes occurs in young girls 
from habits of self-abuse ; and is very liable to attack unhealthy femalea 
on the final cessation of the menses, and occasionally attacks females 
far advanced in life. 



CACHEXIES. 171 



In anal hemorrhage the blood flows principally from the hemor- 
rhoidal vessels ; it is preceded by a sense of pain and weight in the 
rectum ; and, when the patient is of rather full habit, by headache or 
vertigo. 

Special Causes. — The ordinary exciting causes of disease, operat- 
ing upon ail exhausted or depraved organism, in which relaxation of 
Jhe muscular coats of the capillary vessels in a prominent condition, 
may excite either form of hemorrhage we have considered, as the 
predisposition exists, more particularly in the organ or part which is 
the seat of it. All these varieties of hemorrhage are, however, very 
frequently the result of external violence, or symptomatic of other 
local affections, in which case the treatment is to be mainly directed to 
the primary malady. Thus episfaxis may be the result of exposure to 
the direct rays of the sun, sudden and severe cold in the head, violent 
coughing or sneezing, and various emotions of the mind; haemoptysis 
occurs sometimes from an enlarged liver pressing against the lungs, 
suppressed perspiration, straining of the respiratory muscles, excess 
in eating and drinking, suppression of customary discharges, etc. 
Haematemesis is often the consequence of shocks, contusions, vomiting, 
pregnancy combined with constipation, violent passions, schirrus, or 
cancer of the stomach, etc. Hematuria results frequently from a 
blow or a fall, gravel, stone in the bladder, ulceration, severe inflamma- 
tion, and the use of some kinds of irritant drugs, as cantharides. Uter- 
ine hemorrhage is occasionally caused by polypi in the womb, or other 
structural derangements ; and anal hemorrhage is a veiy common 
symptom of hemorrhoidal tumors, or piles. 

Treatment. — The indications are — to excite contraction in the bleed- 
ing vessels, balance the circulation, and invigorate the general system. 
Locally the coldest water, or pounded ice, may be employed, until the 
flow of blood is checked. For nose-bleeding, a cold stream or iced 
water may be applied to the back of the neck, and cold water frequently 
sniffed up the nostrils, at the same time the head should be freely ex- 
posed to the cool or cold air, and the bleeding part be kept entirely 
uncovered. In bleedings from the lungs and stomach, sips of the cold- 
est water, or even bits of ice, may be occasionally swallowed, while 
the coldest compresses are applied over the stomach and chest. In 
bleedings from the urethra and rectum, cold rejections and cold hip- 
baths are the local appliances. In all cases the patient must keep 
quiet, and avoid any source of bodily or mental excitement; and if 
there is feverish heat or inflammatory excitement, the whole body 
must be promptly cooled with the dripping-sheet or ablution. When 
tlie extremities are preternaturally cold, rubbing them thoroughly, first 



172 PATHOLOGY AND THERAPEUTIJS. 

With cold wet cloths and then with dry flannel, is advisable. To accom- 
plish the third indication, we must pursue the appropriate management 
for the restoration of general health. 

Scurvy. — Dr. Good defines the general symptoms of the scurvy — 
scorbutus — " livid spots on the skin from extravasated blood; languor, 
and loss of muscular strength pains in the limbs." 

The first variety, simple 01 petechial scurvy, is almost always a se- 
quel of protracted and debilitating fevers, especially of the putrid type. 
Rarely, however, it occurs in persons of a gross and full habit, who 
are not regardful of hygiene in their personal habits. It is character- 
ized by numerous small spots resembling flea-bites, chiefly on the 
breast, arms, and legs ; the visage is also pale. 

In the hemorrhagic variety — land scurvy — the spots are circular, of 
a purple hue, and of different sizes; sometimes in stripes or patches 
irregularly scattered over the arms, trunk, and thighs ; occasionally 
there is hemorrhage from the mouth, nostrils, or viscera; and there is 
great debility and depression of spirits. In severe cases the patient 
has the bloodless, exhausted appearance observed in anhsemia; and 
blood flows irregularly and often profusely from the lungs, stomach, in- 
testines, and uterus, as well as from the mouth and nostrils. 

In the nautical variety — sea scurvy — the spots are of different hues 
intermixed with livid, principally at the roots of the hairs; the teeth 
are loose; the gums are spongy and bleeding; the breath is very fetid, 
and the debility is extreme. The joints soon become weak, and there 
is often a shrinking of the flexor muscles, rendering the limbs useless, 
and constituting what has been called scorbutic paralysis. The spots 
often coalesce in large blotches, 01 form ulcers, which discharge a 
thin, fetid, sanious fluid, mixed with blood ; and in the last stage blood 
is discharged from the viscera as in the former variety. 

Special Causes. — Stale food, salted provisions, an exclusive flesh-, 
meat diet, and vitiated air, are the ordinary iroducing causes; they 
are almost always associated with inattention to personal cleanliness. 
Either one of these causes alone may produce a modified form of 
scurvy, but all operating together generate the most aggravated cases. 

Treatment. — The proximate condition upon which this disease de- 
pends is a putrescent state of the blood. The indication of cure is, 
therefore, simply, to purify the blood ; and a moderate course of gen- 
eral bathing, with a liberal supply of fresh vegetable and farinaceous 
food, and plenty of good ripe fruit, will answer the indication. On ac- 
count of the extreme laxity and debility, the tepid half-bath, and drip- 
ping-sheet, or towel-wash, are the preferable water appliances Small 



CACHEXIES. 173 



quantities of very cold water should be frequently taken into the stom- 
ach, and when the disposition to hemorrhage is great, cold water enema 
should be occasionally employed. Brown bread, wheaten grits, mealy 
potatoes, and good apples, are the best antiscorbutics known. 

Plethora. — The condition of the body to which nosologists have 
applied this term, is that of general engorgement or over-fullness; it 
is the result o/ excessive alimentation, or defective depuration, or both. 
Full-feeding and inactivity are the producing causes. 

The sanguine, or enionic variety, is distinguished by florid skin, full 
strong pulse, turgid veins, with firm and vigorous muscular fibres; and 
the serous, or atonic, is denoted by a full but frequent and feeble pulse, 
smooth and soft skin, plump but inexpressive figure, and general lan- 
guor or debility of the vital functions 

Treatment- — The remedial measure of first importance is active out- 
door exercise. This may be commenced gently, and gradually in- 
creased; but it should always be to the utmost extent of the patient's 
capacity to endure, short of excessive fatigue. It is of little consequence 
what the kind of exercise is, if it is sufficient in constancy and degree. 
The next matter requiring attention is the food; this must be plain and 
coarse in quality, and in quantity no more than actual nutrition demands. 
A moderate course of the "starvation regimen" for a few weeks would 
accelerate the process of throwing off the superfluity, hardening the 
structures, and invigorating the general system. Lastly, the whole 
surface of the body should have one or two daily washings in cold 
water, followed by thorough friction with a coarse towel or the flesh 
brush. 

Scrofula — Struma — Struma Vulgaris — Scorbutus — King's 
Evil. — The term scrofula — derived from scrofus, a sow — literally im- 
ports swine-swellings, swine-evil, or morbid tumors to which swine are 
subject. Scrofula has long been recognized as a disease common among 
swine, and it is doubtful if any of the domesticated swine are exempt 
from it. It is well known that all hogs fattened in the ordinary method 
are extensively diseased, and a source of disease to those who eat themv 
In this country the general employment of this filthy animal as food, is 
the cause of many morbid affections, manifested under a great variety 
of scrofulous, erysipelatous, putrid, glandular, and skin diseases. 

The Scrofulous Diathesis. — A scrofulous constitution means simply, a 
frail, delicate, infirm, lax organization, a habit of body possessing a pre- 
disposition to the affection called scrofula, and peculiarly liable to develop 
glandular swollings, chronic ulcerations, tubercular formations, and vis 



174 PATHOLOGY AND THERAPEUTICS. 



ceral enlargements, whenever the exciting causes of disease are applied 
with ordinary intensity. The predisposition, however, under favorable 
hygienic influences, may lay dormant through life, and only be called 
into activity in the succeeding generation. The scrofulous constitution 
is said to be characterized by relaxed fibres, smooth and soft skin, fair 
and fine hair, a peculiar fullness and rosy appearance of the face, full 
upper lip, tumid ate nasi, large eyes, long silky eyelashes, delicate 
complexion, large head, precocious brain, great sprightliness with feeble 
endurance. But it must be remembered that this description applies 
only to extreme cases, or an inherited diathesis. The most usual path- 
ological indications of the scrofulous habit are, strumous ophthalmia, 
chronic inflammation aud suppuration of the glands of the neck, por- 
riginous affections of the scalp, enlarged tonsils, rickets, spinal diseases, 
tabes mesenterica, white swellings, inflammation of the membranes of 
the brain, and tubercular consumption. 

Symptoms. — The most common form of the disease — that form 
known as scrofula proper — appears in indolent glandular tumors, fre- 
quently in the lymphatics of the neck, but also often affecting the ex- 
ternal or internal conglobate glands, suppurating slowly and imperfectly, 
and healing with difficulty. In size these tumors usually range from 
that of a pea to that of a chestnut, but occasionally they are much 
larger. In some instances, scrofulous tumors appear in clusters about 
the neck, and armpit, and upon the breast. Usually the tumors which 
appear in infancy subside at the period of maturity. Scrofulous inflam- 
mation frequently attacks the external structures of the eye, the spongy, 
and sometimes the cylindrical bones, and the ligaments, cartilages, and 
membranes around the joints. 

Special Causes. — Whatever deteriorates the general health tends to 
bring the scrofulous predisposition into a state of activity. Various 
forms of scrofulous disease frequently follow severe febrile and obsti- 
nate cutaneous affections, as measles, small-pox, scarlatina, yaws, syphi- 
lis, etc., and are then usually ranked among the sequela? of those dis- 
eases. I think they are much oftener a result of the drug-medication. 
All mineral drugs, and particularly mercury and antimony, which are 
* so freely prescribed in all the above diseases, have a powerful influence 
in exciting inflammatory action and tubercular depositions in scrofulous 
constitutions. Narcotic medicines, as opium, tobacco, alcohol, etc., are 
also efficient exciting causes. The depressing antiphlogistics — vege- 
table, earthy, or saline — as digitalis, senna, polassa, nitre, epsom salts, 
etc., and all debilitating processes, as bleeding, leeching, cauterization 
profuse evacuations, etc., tend to produce a scrofulous diathesis where 
it did not previously exist, and aggravate it when already existent. The 



CACHEXIES. 



scrofulous diathesis may therefore be either inherited or ingene.rated. 
A combination of bud food, impure water, foul air, dark tenements, 
sedentary occupation, and poisonous drugs, is sufficient to produce the 
scrofulous diathesis independent of any hereditary taint. 

Treatment. — The disease before us being one of debility and obstruc- 
tion, invigoration and purification constitute the indications of cure. 
And first among the restorative resources of hygiene are abundance 
of pure fresh air, and plenty of clear sunlight. Sunshine itself is better 
than all the tonics of the nllopathist's materia medica. The food must 
be restricted to the best fruits, vegetables, and farinaceous preparations, 
but allowed in liberal abundance. For city children good country milk 
is essential. The distillery slop-milk, on which so many thousands of 
our infantile population are daily fed, is a fruitful and frightful source 
of scrofulous affections, as well as other fatal diseases. Scrofulous 
patients should, as a genera] rule, drink water rather freely, especially 
in the fore part of the day. Generally one or two full baths — tepid, 
cool, or cold, according to the debility or inflammatory action existing 
— daily are sufficient. Wet compresses should be constantly applied 
to the tumors so long as they manifest preternatural heat, redness, or 
pain ; and the wet-sheet pack, followed by the dripping-sheet or half- 
bath, should be employed daily whenever the whole body is feverish, 
and once or twice a week during the whole course of treatment; a 
moderate douche may be occasionally applied along the spine to advant- 
age ; and when the body evinces symptoms of general obstruction, 
torpor, over-fullness, and turgescence, moderate sweating in the dry 
blanket will be serviceable. Critical boils, eruptions, and abscesses are 
very common under active treatment. 

Cancer — Carcinus — Carcinoma. — The Greek word, carcinus, 
means a crab ; and the disease is thus named from the crab-like rami- 
fications of the dark distended veins of the cancerous tumor. Any 
part of the body may become the seat of this affection, although se- 
cernent glands are most frequently attacked. The breasts of females, 
uterus, testes, glans, penis, tongue, stomach, cheeks, lips, and angles of 
the mouth, are its chief localities. The cancerous diathesis, like the 
scrofulous, may be either inherited or acquired, and, notwithstanding 
many nosologists have regarded this disease as a purely local one, 
the majority now assent to the doctrine that the topical affection 
depends on a peculiar constitutional distemper, taint, or malassimila- 
tion. 

Symptoms. — A cancer commences with a bard, livid, knotty tumor, 
with dark, cancriform varices, intersected with firm, whitish, divergent 



176 PATHOLOGY AND THEEAPEu TICS. 

bands; it is attended with acute, burning, lancinating pains, and termi- 
nates in a fetid, ichorous ulcer, having thick, livid, distorted lips. 

In the breast, the first appearance of the disease is a small indolent 
tumor, which is attended with an itching feeling ; this is followed, after 
a longer or shorter time, by a pricking sensation, and this is succeeded 
by a shooting or lancinating pain eventually a sense of burning is ex- 
perienced, and the skin becomes livid and discolored. Adhesive bands 
are formed in the skin, which becomes puckered, and the nipple is 
drawn inward, sometimes entirely disappearing ; the tumor ere long 
becomes more elevated, and feels knotty to the finger ; at length the 
ulcerative process appears by the integument giving way at different 
points, through whick an ichorous, erosive fluid, sometimes tinged with 
blood, is thrown forth ; as the ulcerative action advances, a broad, deep 
excavation is made, which discharges a most offensive and fetid matter. 

Cancer of the uterus is known by darting pains in the part, shooting 
through the region of the pelvis, and usually indurations in the part, 
which are sensible to the touch ; a preceding and immoderate men- 
strual or leucorrheal discharge, or both ; and as soon as ulceration 
occurs there is a sanious, bloody, or mixed discharge, characterized by 
the peculiar stench of the disease. 

In the vagina and rectum the disease can be ascertained by the 
touch, in connection with the other symptoms ; in the mouth, and on 
various parts of the external surface it is obvious to the sight. 

In the stomach it is with difficulty diagnosticated. An acute and 
burning pain, tenderness of the epigastrium on pressure, nausea, rejec- 
tion of food, offensive fetor in the breath, are together strongly pre- 
sumptive, though not absolutely pathognomonic, of the disease. 

Special Causes. — "Of the remote causes of cancer," says Dr. Good, 
"we know nothing." Other authors confess the same ignorance of 
the proximate cause, and of the nature of the cancerous diathesis. 
The most common of the exciting causes are, external injuries, as 
blows, depressing passions, spirituous liquors, narcotic medicines, gross, 
high-seasoned food, etc. That our friends, the allopafhists, regard the 
disease as in some way or other dependent on or connected with a 
specific virus, is evident from the remedies which are put most promi- 
nently forward, in their books. These are, arsenic, henbane, and 
nightshade — the first, a powerfully corrosive poison, and the last two, 
deadly narcotics. The utter confusion which reigns in the brains of 
medical book-makers concerning the real nature, causes, and proper 
medication of cancer, is evident enough from the following paragraph 
in relation to its treatment, found in Copland's Medical Dictionary. 
After enumerating two or three hundred internal remedies, all of which 



CACHEXIES. 177 



have enjoj^ed a higb reputation, but which cannot now be depended on, 
comprising, in fact, nearly all the strong, pungent, powerful, and pois- 
onous drugs and chemicals of the apothecary shop, our author remarks : 

"Of the numerous external remedies recommended at various 
periods, the preparations of arsenic, and quicksilver, charcoal and carrot 
poultices ; the mineral acids, particularly chlorine, hydro-chloric, and 
chloric acids ; the chlorurets, and many of the metallic suits ; camphor, 
the balsams, and the terebinthinate substances; ammoniacum, galba- 
num, and myrrh; and the greater part of the astringent, antiseptic, 
detergent, and stimulating vegetable medicines, have obtained a greater 
degree of reputation ; and when some of them are judiciously combined 
with one another, and with narcotics, they are deserving of notice us 
discutients in the early stage of the disease, and as. palliatives in its 
ulcerating state." 

Treatment. — The constitutional treatment for cancer is essentially 
the same as for scrofula; and all that has been recommended for 
scrofula, in the matter of diet and regimen, is applicable here, with 
this exception — cancer requires even a more rigidly simple and a very 
abstemious diet. €n this disease the "hunger-cure" is an indispensable 
auxiliary, or rather, perhaps, the leading remedial measure. Several 
cases are on record of foul, fungous, and cancerous tumors, which 
had resisted caustics and the knife, being cured by a simple and strict 
dietary. jThe celebrated Dr. Twitchell, of New Hampshire, was 
cured, a few years ago, of a malignant tumor of the lip, which had 
been extirpated once, and repeatedly cauterized in vain, by restricting 
himself to a diet of bread and cream, the quantity being barely suffi- 
cient for necessary nutrition. Brown bread, parched corn, or other 
grain, with a moderate allowance of good fruit, and plenty of soft water 
for drink, constitute a dietary it would be difficult to improve upon. 
In all diseases connected with general depravity of the secretions, and 
in all cases where a strict diet is advisable, a good proportion of the 
food should be hard or solid, for the double purpose of insuring com- 
plete mastication and better guarding against excess in quantity. Med- 
ical authors of the old school are generally opposed to "low diet," in 
this disease ; but with them low diet means slop food, and high, or 
"generous" diet implies stimulating or animal- food. I am opposed to 
both of these plans, not only in this disease, but in all others. 

Every measure which can in the least conduce to the general invig- 
oration of the system, must be unremittingly employed. Abundance 
of fresh and pure out-door air is indispensable, and, as in scrofula, one, 
two, or three general baths may be employed daily. There is but 
litte to ;hoose between the different kinds of baths; the dripping- 



178 PATHOLOGY AND THERAPEUTICS 

sheet, half-hath, ov plunge, as either is most agreeable to the patient's 
feelings. It is generally, however, important to deterge the skin thor- 
oughly, and keep up a good degree of activity in the cutaneous excre- 
tory process, by occasional packings in the wet sheet, so managed as to 
produce moderate but not debilitating sweating ; or, in very torpid in- 
valids, the dry-packing, followed by the dripping-sheet, with very active 
friction, may be substituted. 

The local treatment is a matter of more difficulty. Extirpation will 
generally succeed, if resortel to in the early stages, provided the gen- 
eral health has been judiciously cared for; but it unfortunately happens 
that the operation is not often resolved upon until structural disorgani- 
zation has proceeded too far to render it available. There is no 
doubt that, in some cases in which the local affection is much more prom- 
inent than the constitutional, caustics, or rather, perhaps, chemical an- 
tidotes, have been successful. The matter of a cancerous growth, 
being an abnormal formation, can, without doubt, be acted upon and 
destroyed, and the peculiar action or secretion on which its existence 
depends arrested, by substances which will not act very injuriously on 
the healthy structures, nor materially interfere with the normal func- 
tions ; but as yet we are ignorant of any such specifics or antidotes. 
The "cancer quacks," it is well known, use arsenic as the principal 
corrosive to eat away the diseased structures ; but death often results 
from the absorption of the poison. Iodide of potassium, and nitrate 
of silver are reported, on good authority, to have, in a few instances, 
destroyed the cancerous ulcer, which did not subsequently reappear. 
Some vegetable powders, as bloodroot and blue cohosh, have had a 
similar reputation. It is certain, however, that all these preparations 
fail in a majority of cases, and an anti-cancerous remedy is yet a de- 
sideratum, if indeed it is a possibility. My friend and former patient, 
Dr. Schell, late of New Orleans, assures me that he is in possession 
of an antidotal preparation which operates destructively on the diseased 
parts, and correctively on the morbid action, without sensibly injuring 
the sound structures. As he is about to put the matter to a practical 
test on an extensive scale in this city, I need not dwell longer on the 
subject in this place, save to remark that Dr. S. is not one of the 
numerous professionable 'adventurers who are swarming in all our great 
cities, but a scientific, candid, and honorable physician. It is due, how- 
ever, to him and to the subject to say, that he depends as much on 
constitutional as on local treatment, deeming the latter useless without 
attention to the general health, this attention to be in all respects 
strictly hydropathic. 

I have not yet had ai opportunity of resting refrigeration, or the 



CACHEXIES 178 



applicatiou of extreme cold to a cancerous tumor ; but, judging theo- 
retically, I should expect much benefit from it. It is always advanta- 
geous to keep the diseased part covered with wet compresses of as cold 
temperature as can be borne without increased pain ; aud I cannot help 
believing that actually freezing the part occasionally, by the application 
of refrigerating mixtures, is among our most promising topical appli- 
ances. 

Melanosis. — The disease jailed melanose, or black cancer, consists 
in the formation of a morbid product of secretion, of a dark color, more 
or less inspissated, and staining or studding the organ or structure af- 
fected. Every p;irt of the body is liable to these discolorations or tu- 
bercles, and sometimes all the structures are loaded with them. In 
the areolar texture the melanotic matter often accumulates in the cells, 
and forms tumors of various sizes. 

Symptoms. — The color of melanosis varies from a dark yellow to 
brown, deep blue, approaching to black, and to complete black, which 
is the most common. The secretion is easily detected by its peculiar 
shades of color in any part or organ containing it, as the surrounding 
tissues are lighter colored, and form a remarkable contrast with it ; it 
is usually of a pultaceous consistence, the tubercles pea-sized to walnut- 
sized, and scattered in groups ; they are sometimes situated upon the 
surface, but more generally below it ; an irritative fever, mostly of the 
hectic form, attends, and the patient experience's great debility. The 
secretion is neai'ly destitute of smell and taste ; and os no vessels or 
Derves have ever been in it, the matter appears to be an unorganized 
deposit. 

Prognosis. — Dr. Good remarks : " The cause, progress, and diag- 
nosis, are at present obscure and unsatisfactory, and the treatment is 
yet to be learned." The majority of cases have thus far, under allo- 
pathic treatment, terminated fatally. 

Treatment. — This need not detain us. The cure depends on restor- 
ing the normal condition of the secernent system, and this presupposes 
the employment of all the means for invigorating the general system 
and purifying the circulating fluids, which have been detailed under 
preceding heads, more especially when treating of scurvy, scrofula, 
nnd cancer. 

Catal \usis. — This is a condition of general combustibility of the 
body, produ ed by the use of alcoholic drinks. Examples of sponta- 
neous combustion as having occurred in persons long accustomed to 
the immoderate employment of spirituous liquors, are too well authen' 



180 



PATHOLOGY AND THERAPEUTICS. 



ticated to be longer doubted. The condition of body liable to this strange 
phenomenon may properly be called the alcoholic diathesis. In a major- 
ity of cases recorded, females advanced in life were the subjects of 
the malady. In some cases the self-consuming flame has arisen with- 
out any obvious exciting cause ; but in others, a fire, a lighted candle, 
the heat of a stove, or an electric spark, has ignited the inebriate 
body. It is a remarkable fact that the flame which decomposes and re- 
duces every fragment of the bodily structure to ashes, does not essentially 
injure the common furniture or bedding with which it comes in con- 
tact ; and more marvelous still is the statement that water, instead of 
quenching the fire, seems rather to quicken it. As this is the only mor- 
bid condition known which renders the human body combustible, and 
the only morbid fire which hydropathy cannot extinguish, the subject 
need not be further prosecuted, save to point the obvious moral for the 
benefit of whom it may concern — that all spirit-drinkers burn, and mar, 
and disorganize their structures in an exact ratio to the amount of alco- 
hol they consume, even if the alcohol does not consume them by a 
spontaneous, ingenerated fire in return. 



CHAPTER. VII. 



DISEASES OF THE EYE. 



The morbid conditions of the visual organ requiring attention in this 
place may be arranged as in the following table : 



Ophthalmia 



Structural Derange- 
ments affecting the 
Sight 




f Psorophthalmia, 
! Trichiasis, 



Structural Affections 
of the Eyelids 



Entropium, 

Ectropium, 

1 Hordeolum, 

Excrescences, 
| Ptosis, 
[Fistula Lachrymalin, 

f Asthenopia, 
Hemeralopia, 
of Vision > Nyctalopia, 
Myopia, 
I Presbyopia. 
i Ecchymosis, 
Injuries and Accidents ■! Extraneous Substances, 
y Burst Eye. 

The most common morbd affection of the eye is inflammation. It 



DISEASES OF THE EYE. 181 

may attack any of its structures, but is most frequently seen in the 
membrane covering the external coat constituting the ophthalmia 
proper, or ophthalmitis of authors. Sclerotitis, iritis, retinitis, etc., 
designate, in technical Latin, inflammatory states of the sclerotic, iris, 
retina, etc. As they should all be treated precisely in the same man- 
ner as acute or chronic ophthalmia, as the violence or mildness of their 
symptoms approximates the character of either, they need not be sep- 
arately considered. 

Acute Ophthalmia. — This is the common form of active inflam- 
mation. It commences with a pricking sensation, as though dust was 
in the eye, soon followed- by heat, redness, swelling, and extreme in- 
tolerance to light. Often there is severe headache, with more or less 
general fever. 

Treatment. — Keep the eye shaded from strong light, but not con- 
fined from the air by close bandaging. Apply linen cloths wet in cold 
water, changing them very frequently, until the temperature becomes 
natural, and the redness disappears. Wet the head often in cold wa- 
ter. If there are irregular chills and heat, employ the wet pack sheet 
once or twice daily for an hour, followed by the cold ablution. Move 
the bowels freely with tepid water iujections. If the feet are cold, 
use warm foot-baths. The patient should eat nothing stronger than 
water-gruel, and but little of that, until the violence of the disease has 
very materially abated. 

Chronic Ophthalmia. — This condition of sore eyes often results 
from riotous living, bad air, bad food, liquor, tobacco, etc., and is very 
often a sequel of maltreated acute ophthalmia. Millions of eyes are 
rendered miserable to look upon, or from, by the drugifications of doc- 
toring, washes, lotions, leeching, blistering, bleeding, calomelizing, etc., 
to cure the acute form. 

Treatment. — Particular attention must be paid to the general health. 
A daily rubbing-sheet, and a daily hip-bath, should be part of the treat- 
ment. Walking foot-baths are excellent auxiliaries. The eyes should 
be bathed several times a day in moderately tepid water at first, and 
finally as cold as may be found consistent with comfortable sensations 
after the application. 

Purulent Ophthalmia — Egyptian Ophthalmia. — This form of 
inflammation is rapidly destructive, and requires prompt nnd energetic 
treatment. In addition to the pain, heat, and redness of acute oph- 
thalmia, it is characterized by the enormous swelling of the eyelids, 



182 PATHOLOGY AND THERAPEUTICS. 

soon followed by the discharge of a large quantity of thick, yellowish. 
or greenish matter. 

Treatment. — If them be much general heat of body, the wet-sheet 
packing should be employed two or three times a day, followed by 
washing the surface in tepid water. If the body incline to chilliness, 
the sheet should be wrung out of warm water. The ej r es are to be 
very frequently washed with pure soft water, warm at first, then tepid, 
and then cold — never very cold. Attend to the bowels as above. 

Infantile Ophthalmia — Purulent Infantile Ophthalmia. — 
Children of a few days or weeks old fl.re often attacked with this for- 
midable malady. The symptoms, however, usually come on with less 
violence, and progress less rapidly. But the common lotions and po- 
tions, washes and swashes, are very apt to aggravate the disorder, de- 
form the eyelids, or destroy the sight. The treatment is the same as in 
the case of the adult, substituting the warm or tepid bath for the pack. 

Granulated Ophthalmia— Granular Eyelids. — In this affec- 
tion the conjunctival membrane, or white of the eye, is raised into 
little projections, presenting a rough, irregular appearance. It is a 
consequence of long-continued or maltreated inflammation. If not 
cured, it may in time occasion opacities of the cornea, by the irritation 
it causes, followed by blindness. The only chance of cure hydropath- 
ically is by a persevering course of general and local treatment. Mod- 
erate bathing, say a daily rub-sheet and douche, the local application 
several times a day of very cold or iced water, or even pounded ice, 
with a strictly abstemious regimen, carefully avoiding all exciting con- 
diments, and all sorts of stimulants, constitute the outlines of the rem- 
edial plan. 

Nebulje and Specks, or Opacities of the Cornea.— Nebula) 
are superficial deposits in the transparent part of the eye, giving it a 
cloudy appearance; opacit es are deeper seated, producing a dense 
and pearly appearance. They are caused by inflammation. Their 
treatment should be managed precisely as for granular eyelids, with the 
addition of means to excite powerful absorption. A strong douche and 
walking foot-baths are the best measures for this particular indication. 

Ulcers of the Cornea.— These occasionally result from long- 
standing inflammation, and are also sometimes produced by mechani- 
cal and chemical irritants. The treatment is, in all respects, as the 
preceding. 



DISEASES OF THE EYE. 183 

Ptertgium. — A small reddish triangular tumor, growing from the 
inner cornea of the eye, or from some portion of the eyelid. It can 
be readily removed by cutting, the operation being entirely painless. 

Staphyloma. — A pearly, conical, whitish tumor, formed by tne 
enlarged cornea projecting between the lids. It is the consequence 
of severe ophthalmia, and of badly-managed eruptive fevers, as the 
small-pox. It can only be removed by a surgical extirpation ; though 
a rigidly abstemious and hygienic regimen might, in many instances, 
prevent the disease from proceeding to a dangerous extent. The sight 
is always destroyed. 

Closed Pupil. — Inflammation of the iris is sometimes followed by 
an obliteration of the pu - '' Vision is often partially restored by form- 
ing an artificial pupil. 

Cataract. — This is an opacity of the crystalline lens or its capsule. 
Its progress is very slow, and it generally commences without any ap- 
parent cause. The first symptom of the approaching disease is indis- 
tinct vision. Objects seem enveloped in a mist before the eyes. A 
speck can then be observed in the center and behind the pupil. As 
the opacity increases, the sight grows dim, and vision is better in a 
moderate than a strong light. 

Treatment. — Surgeons have three operations for its cure. 1st. 
Breaking up the crystalline lens with needles, which is probably the 
best. 2d. Depressing or pushing the lens aside from the angle of 
vision. 3d. Extracting the lens. 

When this affection is first discovered, its further progress may be 
arrested, and possibly a cure effected, by the management applicable t* 
nebulae, specks, etc. 

Amaurosis — Drop Serene. — A total or Dartial loss of vision from 
paralysis of the optic nerve, or an affection of the nervous structure 
of the retina. It is produced by inflammation, severe exposure to in- 
tense light, intemperance,, gluttony, tobacco, alcoholic liquors, excessive 
night labor, etc. Milton was a notable example of this affection. The 
defect of vision comes on gradually ; letters and other objects at first 
look misty or confounded, or run into each other; sometimes objects 
seem double, and at other times- portions of objects are undistinguish- 
able. Between the objects and the eye, numerous insects, cobwebs, 
or other substances seem to be interposed. The eye itself manifests 
little or no change to the obser-sr. Sometimes flashes of light appear 



184 PATHOLOGY AND THERAPEUTICS. 

before the eyes, and the head is often affected with vertigo, pain, and 
heaviness. 

Treatment. — Confirmed amaurosis is incurable. If taken in its in- 
cipient stage, it may be arrested and generally cured. Being essen- 
tially a disease of exhaustion, the full hydropathic system should be 
thoroughly and perseveringly applied. The general or constitutional 
treatment is mainly to be relied on, the local applications being of sec- 
ondary importance. The simple and single indication is, to invigorate 
the whole system. The rubbing wet sheet, the pack followed by the 
shallow-bath or plunge, sitz, and foot baths, with occasional douches, 
should be adapted discriminatingly to the particular condition of each 
case. Every part of a hygienic regimen is important. In no disease 
is strict temperance in eating and drinking more indispensable. A lit- 
tle of the " hunger cure" would be serviceable in all of these chronic 
maladies of the eyes. 

Strabismus. — Squinting, or cross-eyes, is sometimes congenita], and 
sometimes produced by diseases and accidents. Measles, dropsy in the 
head, worms, looking too much at objects obliquely, are exciting causes. 
-More generally it results from a permanent contraction of a particular 
muscle which holds the eye in a wrong direction. It is curable, by di- 
viding the obnoxious muscle, an operation scarcely painful or dangerous. 

Psorophthalmia. — A form of chronic inflammation of the eyelids, 
attended with itching, redness, watery discharge during the day, and a 
sticky, glutinous secretion durii.^ sleep. Its causes and treatment are 
the same as of chronic ophthalmia. 

Trichiasis. — Irritative soreness of the eye, from the eyelashes 
growing in toward the ball. Extract the inverted hairs, and bathe 
often in cool water. 

Entropium.— The eyelid is sometimes inverted, or turned inward. 
It requires surgical treatment, viz., the careful excision of the inverted 
edge of the lid. 

Ectropium.— An eversion or turning outward of the eyelid. It cre- 
ates a hideous deformity, and the lid must be excised as for entropium. 

Hordeolum.— Commonly known as stye. It consists of a small in- 
flammatory tumor near the edge of the eyelid. It is very painful, but 
generally suppurates and heals in a few days. Frequent bathing of the 



DISEASES C F THE EYE. 185 

affected part wi'.h water of a temperature most agreeable to the feel- 
ings, lessens the pain and accelerates the cure. 

Excrescenses. — Wart-like and other trifling tumors sometimes 
form about the eyelids ; they are easily and safely clipped off with the 
knife or a pair of scissors. 

Ptosis. — A hanging down of the eyelid over the eyeball, from re- 
laxation or paralysis of the muscle, whose action elevates the lid. 
Frequent cold bathing, occasiona head-baths, gentle manipulations over 
the eye with the bare hand, and attention to the general health, are all 
proper, and generally all are necessary. 

Fistula Lachrymalis. — This is a stoppage of the tear passage, 
caused by obstruction from a thickening of its lining membrane. The 
tears, instead of passing off by the nose, run over the cheek, giving 
the eye a watery appearance, especially when exposed to wind or cold. 
In protracted cases a swelling occurs at the inner angle of the eye, 
sometimes forming matter. It requires to be treated on the same gen- 
eral plan as ptosis. Usually the general health is so disordered as to 
render a rigidly abstemious diet advantageous. In bad cases it may be 
necessary to probe the obstructed canal, or wear an artificial tube. 

Asthenopia. — Weak vision. This depends on constitutional or local 
debility, and requires the full invigorating plan before mentioned. 

Hemeralopia. — Day-blindness. A peculiar sensibility of the re- 
tina, by which the patient sees better in the evening than in clear 
daylight. The Albino manifests more or less of this condition. It is 
irremediable. 

Nyctalopia. — This is the reverse of the former condition, the 
subject having natural vision in the daytime, but very imperfect in the 
evening, or twilight. Glasses sometimes assist this night-blindness to 
some extent. 

Myopia. — Short-sightedness. The subject cannot read, ordinary 
print well beyond the distance of fifteen or sixteen inches. In looking 
at distant objects, he half closes the eyelids. It is most common in 
young persons. The oculists remedy this defect by concave glasses. 
Manipulations have been found successful as the difficulty depends on 
too great convexity of the globe of tbe eye Flattening the eyeball by 



186 



PATHOLOGY AND THERAPEUTICS. 



pressing gently with the fingers across it, from within outwardly, tenda 
to restore the proper local point of vision. 

Prksbyovia. — Far-sightedness. The subjects of this complaint 
read with the book or paper at the distance of two feet of more. The 
corner is too flat, the pupil is contracted, and the eyes have a more 
sunken appearance. It is most common to aged persons. Convex 
glasses are prescribed by the oculists. The defect may be finally over- 
come in many persons by manipulating from without toward the nose, 
so as to increase the roundness of the eyeball. Press the fingers gen- 
tly from the outer angle of the ey ■» inward, and rather around than 
across the globe. 

Ecchtmosis. — "Rowdy's coat of arms." This is the common black 
e} 7 e of rowdy characters. Generally it comes from an unlucky blow, 
but a fall, sting of an insect, or leech bite, may produce it. Bathe 
freely in the coldest water. 

Substances in the Eye. — Foreign bodies often insinuate them- 
selves between the eyelids, causing great pain. Draw down the lower 
lid (fig. 183), and remove by a piece of moistened paper. If the sub- 
stance be under the upper lid, place a bodkin across the lid, and draw 

Fig. 183. Fig. 184. 




DEPRESSING THE LOWER LID. 



INVERTING THE UPPER LID. 



back the lid so that it is completely inverted (fig. 184). Very minute 
pieces of iron are often driven with such violence that a surgeon is 
compelled to cut them out; but the operation should not be attempted 
by other parties, as they may destroy the eye. Inflammation is very 
apt to occur after these accidents, for which the eye should be well 
bathed with tepid or warm wafer frequently, until the pain abates; then 
follow with cool, and finally cold applications. 



] ISEASES OF THE EYE. 



187 



Lime and Roman cement are very destructive to the eyes. Wash 
repeatedly with a mixture of a table-spoonful of some vegetable acid in 
a tumbler of water, as vinegar or lemon juice. 

Burst Eve. — From severe blows the eye is sometimes burst. Do 
not attempt to touch it, as vision may be irremediably damaged by 
touching it with the finger. The careful surgeon will frequently be ena- 
bled to preserve sight. Place the patient at once in bed, darken the 
room, and treat the subsequent inflammation with cool compresses. 



CHAPTER VIII. 



DISEASES OF THE EAR. 

The various abnormal affections of the organ of hearing may be con- 
veniently grouped under the general heads of inflammation and deaf- 
ness ; the kinds of the inflammatory affection constituting the varieties 
of the former, and the causes of the malady forming the varieties of 
the latter. This arrangement, I confess, has nothing classic or system- 
atic to recommend it; nor will it embrace two of the diseases belonging 
to the chapter, which must, therefore, be placed under a third head, 
thus : 

( External Acute Inflammation, 
Otitis { Internal Acute Inflammation, 

I Chronic Inflammation. 

From Cold, 

" Hardened Ear-wax, 

" Excrescences, 

" Abscess, 

" Caries, 

Deafness \ " Altered Membrana Tympam, 

" Diseases of the Eustachian Tube. 

" Extravasation, 

" Nervous Affections, 

" Dumbness, 

" Senility. 

_. < Earache, • 

Promiscuous < _, „ ,. , T . 

I F^-eign Bodies and Insects. 



188 TAUTOLOGY AND THERAPEUTICS. 

Inflammatory affections of the ear have usuully been distinguished 
by nosologists into acute and chronic ; the former being termed otitis, 
the latter olorrhaa. Otitis has been divided into external and internal, 
as it affects chiefly the external or internal ear; and otorrhea has been 
regarded as mucous or purulent, according to the character of the' dis- 
charge. Other distinctions have been oredicated on the causes of the 
disease, as scrofulous, syphilitic, etc 

External Acute Otitis. — Acute inflammation of the external 
ear commences with slight pain, or sense of heat, or intense irritation, 
or itching, followed by more acute and distressing pain. The pain is 
augmented on pressure, by the motions of the lower jaw, and generally 
by the contact of very cold air, or very warm fluids. Hearing is con- 
fused, and unusual noises trouble the ear, and sometimes, within three 
or four days, a thin fluid is discharged from the meatus, which gener- 
ally soon becomes thicker and puriform. Sometimes it is greenish, 
fetid, and extremely acrid. When the inflammation subsides, the mat- 
ter hardens into a caseous or cheesy consistence, which, unless removed, 
obstructs the passage, and occasions partial deafness. 

Treatment. — This is plain and simple. Fasting until the inflamma- 
tory stage materially subsides ; the constant application of several folds 
of cold wet cloths to the part ; occasionally syringing the ear with cool 
but not very cold water ; and general bathing, once, twice, or thrice a 
day, by means of the dripping-sheet or wet-sheet pack, comprise all 
the needful plan of medication. 

Internal Acute Otitis. — Acute inflammation of the internal ear 
is attended with a distressing sense of distention, painful throbbing, and 
nervous disturbance, consequent on the obstruction of the Eustachian 
tube, and the difficulty of discharging the secreted matter externally. 
The pain is deep-seated ; there is often a feeling as though the ear 
would burst, and loud, clanging, or beating noises are heard, and the 
ear is painfully susceptible to scmd. In some cases the face is flush- 
ed, the eyes are red and watery, the head delirious, and the attending 
fever of the typhoid character. If the disease is not speedily relieved, 
suppuration takes place, and the accumulated matters are discharged 
through an ulcerous perforation of the membrane of the drum, or into 
the throat by the Eustachian tube, or by a fistulous opening in the 
mastoid process of the temporal bone. The former is the usual termi- 
nation ; the second seldom occurs ; and the latter result is extremely 
rare. Structural changes sometimes result from internal otitis, which 
partially or totally destroy the sense of hearing. 



DISEASES Ob' THE EAR. 189 

Treatment. — This disease should be met with prompt and vigorous 
treatment. In addition to the processes recommeuded for the preced- 
ing variety, cold water should be poured over the sides and back of the 
head, several times a day, and several minutes at a time, or until the 
preternatural heat of the head is thoroughly subdued. The wet sheet 
must be resorted to sufficiently to keep down the general fever; and 
the bowels should be kept well cleansed by tepid injections. In some 
cases the purulent matter becomes so inspissated that it makes its way 
through the opening in the memhrana tympani with great difficulty, in 
which case its discharge may be facilitated by very frequent injections 
ot warm water into the external meatus. Sometimes the Eustachian 
tube is entirely obstructed ; this fact can be ascertained by causing the 
patient to make a forcible attempt at expiration with the mouth and 
nose closed ; if the tube bo permeable, bubbles of air. mixed with the 
fluid secretions, will escape at the external meatus. If the early treat- 
ment is thorough, and thoroughly hydropathic, this affection will almost 
always terminate by resolution, leaving none of those deplorable results 
which are so common, as sequela?, after a course of allopathic manage- 
ment. Indeed, under the ordinary drug-treatment the disease often 
continues with violence from three to six weeks, and not unfrequently 
results in a complete disorganization of the internal ear. 

Chronic Inflammation — Otorrhea. — A prolonged discharge, or 
running from the ear, is frequently the consequence of acute otitis, 
and often one of the sequelae of maltreated eruptive fevers, particu- 
larly small-pox, scarlet fever, and erysipelas. The mucous form is the 
most common among delicate and scrofulous children, and frequently, 
under the popular system of treatment, continues for years. The 
purulent variety is often connected with caries, or ulceration of the 
surrounding bony structure. The patient, in this case, complains of a 
dull pain in the ear, extending over the side of the head ; of impaired 
hearing ; and exhibits a dullness and heaviness of expression. The 
mastoid process is oftentimes the seat of ulceration, the external parts 
being then swollen and cedematous. 

Treatment. — All forms of chronic abscesses, ulcerations, mucous or 
purulent discharges from the ear, should be treated on one and the 
same general plan. They always indicate depravity of fluids, or de- 
bility of functions, or both; hence the uniform indication is to cleanse, 
or strengthen, or both. First of all, the general health must be at- 
tended to. The co*-se, plain, farinaceous, and frugivorous diet, a care- 
ful abstinence from all saline, alkaline, or greasy foods or condiments, 
with a persevering application of such forms of general bathing as the 



190 PATHOLOGY A.^D THERAPEUTICS. 

general constitutional condition demands, are the essentials of the plan 
The rubbing wet sheet, with frequent hip and foot baths, as derivatives, 
make a good bathing arrangement. If the skin is obstructed of bilious, 
the pack sheet should be occasionally resorted to ; and it is more or 
less frequently useful in nearly all cases. After the general health lias 
become substantially improved, warm, and then tepid, and then cool 
injections, should be thrown into the ear, if, as is usually the case, there 
is more or less deafness, and this should be persevered in for weeks 
and months, if necessary. 

Deafness. — The pathological conditions, structural and functional, 
of the various parts entering into the formation of the ear, which may 
produce a greater or less depravation of the sense of hearing, are very 
numerous ; and many of them are exceedingly difficult of diagnosis. 
Fortunately, the worst cases are of rare occurrence ; and those which 
are common are easily discriminated, and successfully treated. 

Deafness from Colds. — A state of atony, or sub-paralysis of the 
auditory nerves, from "taking cold," frequently occasions deafness in 
one or both ears, for days, weeks, or months. It is curable by perse- 
vering tepid injections, with due attention to the general health. 

Deafness from Hardened Ear- Wax — An accumulation of hard- 
ened wax, obstructing the function of hearing, is generally the result 
of an erythematic inflammation of the auditory passage. Persons of 
bad habit of body, torpid skin, deranged digestion, etc., are peculiarly 
liable to this affection. It is known by an increased sensibility or sore- 
ness in the meatus, a sense of itching, and often a burning or pricking 
sensation, confusion in the head, noises in the ear, with a tearing or 
dragging sort of pain about the ear and head. 

It is curable in the same manner as the preceding ; but due attention 
to the general health is the leading indication ; and among the most im- 
portant of the hygienic appliances is a rigidly plain and unconcentrated 
diet. Head-baths are useful when the inflammatory symptoms are 
prominent. 

Deafness from Excrescences. — Morbid excrescences, usually soft 
wart-like tumors, or spongy vesicu'.ar polypi, are sometimes found in the 
ear-passage. They are the result of chronic inflammation of the folli- 
cles of the meatus, or the membrana tympani. ffhese excrescences 
are red, sensitive, and readily bleed when irritated, except in a few 
cases, when they are hard and indurated. To detect their character 



DISEASES OF THE EAR. 1M 

the meatus must be examined with the ear speculum, o\ a common tri- 
angular reflecting prism of flint glass, by which light can be sent to the 
bottom of the external ear-passage. 

Treatment. — In treating these conditions, the inflammatory action 
should be subdued, and the general health restored, as already mention- 
ed, and then the fungus growths extirpated, after which, both tepid and 
cold injections should be employed for a considerable length of time. 
The polypi and other tumors can generally be eradicated by a pair of 
fine curved scissors, or a curved double-edged knife, having a blunt and 
rounded extremity, or a pair of delicate forceps, with sharp points, or 
with a ligature passed around them, and occasionally tightened until 
they are cut off. Such excrescences as are incapable of removal by 
mechanical means, can generally be destroyed by caustics, for which 
purpose they may be repeatedly touched with nitrate of silver. Its 
employment demands great care, to prevent the sound parts from 
being cauterized also. 

Deafness from Abscess. — The abscess is a phlegmonous inflam- 
mation of the cellular tissue of the passage, usually caused by severe 
cold or exposure to strong currents of air. It should be treated pre- 
cisely like acute inflammation. 

Deafness from Caries. — Some persons are affected with, and 
children of a scrofulous diathesis are very liable to, an inflammation of 
the periosteum, which generally results in inflammation of the bonj 
structure, and frequently terminates in exfoliation of the diseased bone, 
by which the passage is narrowed or obliterated. The inflammatory 
stage should be treated by the means previously recommended, and 
as the healing process goes on, the passage should be prevented from 
closing by caustic or metallic tubes. The hearing always remains dull 
in these cases. 

Deafness from an Altered Membrana Tympani. — Neglected 
or maltreated inflammatory affections are occasionally followed by a 
thickening, opacity, fungous excrescence, or destruction of the mem- 
brane of the drun Sometimes the membrane, examined by the 
speculum, appears as if covered by small projecting glands or follicles; 
at other times it is very red and vascular; the blood-vessels being dis- 
tinctly visible. The pain is accompanied by buzzings, as if something 
were fluttering in the ear, and by diminished hearing. The pain is 
increased by loud sounds, by variations of temperature, and by press- 
ure upon the ear. 



192 PATHOLOGY AND T J. Elt APE U T ICS. 

Treatment. — There is nothing peculiar in the treatment of this af- 
fection, as distinct from that of the other forms of inflammation and its 
consequences, alreaJy described. It is worth remembering, that in 
many chronic diseases of the head, and particularly of the ears, deriva- 
tive, hip, and half-baths are among the best applications. They should 
be as lengthy as the patient can bear them, without disagreeable feel- 
ings in the brain or lungs, generally thirty or forty minutes. Artificial 
perforation of the membrana tympani has been frequently performed 
in cases where it was so thickened as to nearly or quite destroy the 
hearing ; but it has seldom succeeded in restoring it. 

Deafness from Diseases of the Eustachian Tube. — The 
Eustachian tube is sometimes obstructed by the presence of tumors in 
its vicinity, by inflammation resulting in swelling of the mucous mem- 
brane, effusion, constriction or obliteration of a portion of the canal. 
These conditions cannot well be ascertained without explorations by 
ear forceps or catheters. Injections of warm water, and of air, have 
been employed to ascertain the nature and extent of any existing ob- 
struction ; but all these operations are attended with no small degree 
of danger. Several fatal accidents are recorded in medical journals, 
as having recently occurred in London, from the pumping of air from 
a press into the Eustachian tube. The wisest policy in these import- 
ant cases is to be c/wtent with the thorough employment of all meas- 
ures conducive to the general and local health. 

Catarrhal affections, inflammation of the throat, and eruptive fevers, 
not unfrequently leave an accumulation of mucus in the Eustachian 
tube, obstructing it, and occasioning more or less deafness. In such 
cases cold water gargles are an excellent addition to the general plan 
of treatment. 

An inflammation principally confined to the mucous membrane of 
the Eustachian tube, which is often but the extension of a disease of 
me throat, frequently causes deafness. When this inflammation is 
confined to the guttural part of the tube, the patient hears well at 
times, but only momentarily. His own voice sounds worse to him 
than the voices of others, and has sometimes a gurgling, crackling, or 
detonating sensation. The pain is greatly increased on gaping, or by 
the act of mastication. Ice-cold gargles, with the whole general anti- 
inflammation treatment, should be perseveringly employed. 

Enlarged tonsils sometimes press upon the guttural extremity of the 
Eustachian tube, so as to produce deafness, as also do fungous excres- 
cences, polypi, and enlarged parotid glands. Those obstructions, of 
course, must be removed by ligature or excision ; though enlarged ton- 



DISEASES OF THE EAR. 193 

sila can generally be reduced by cold gargles, and thorough general 
treatment, with a rigidly abstemious diet. 

Deafness from Extravasation. — External injury, violent sneez- 
ing, or severe constriction of the neck, may produce a lesion, causing 
an extravasation of blood in the cavity of the drum. Cold compresses, 
gargles, injections, and any other baths demanded by the state of the 
general system, will generally produce an absorption of the extrava- 
sated fluid, if it does not pass off by the Eustachian tube, and remove 
the deafness. 

Nervous Deafness. — The term nervous, in this sense, is very in- 
definite. It is applied by medical authors indiscriminately to all forms 
of impaired hearing, unconnected with apparent inflammatory pheno- 
mena or structural changes. The proximate causes of this form of 
deafness are numerous : it may arise from simple atony, paralysis, or 
exhaustion of the nerves pertaining to the sense of hearing, or those 
nerves may be compressed by tumors, purulent formations, or ex- 
travasations, not manifested by any external symptoms ; or from organic 
affections of the brain pressing on the origin of the nerves. 

The most prominent symptoms which indicate compression of the 
nerves are vertigo or dizziness, severe and constant headache, noise in 
the ears, weak sight, and defective memory. It is generally incurable, 
although the means applicable to the preservation of the general health 
may prevent the further progress of the condition producing the deaf- 
ness ; and in some cases the hearing may be greatly improved by the 
same sanatory measures. 

Palsy of the acoustic nerve arises from severe shocks, contusions of 
the brain, convulsions, apoplexy, fever, plethora, and still more fre- 
quently from sympathy with some chronic derangement of other parts 
or organs, generally the digestive. The reader need not, perhaps, be 
told that in all the affections of this class, which, in fact, are many, the 
prospect of cure depends entirely upon the degree of general health 
which can be reproduced. 

Dumb Deafness. — Deafness in infancy may arise from original 
constitutional malformation, or from structural diseases occurring in the 
early periods of life. When congenital, it is incurable ; but in many 
<:ases resulting from diseases in the first few years of existence, a 
cure may be effected by careful attention to the local condition and 
general health ; it is especially important to avoid all concentrated and 
stimulating articles of food in these cases. 
IT— 17 



191 P A T H L G Y A N 3 i H E R A P €. D TIC S. 



Skmli: Deafness.— Old age should nor, in a natural development 
and decline of the bodily functions, be subject to deafness, blindness, 
nor other loss of external sensibility, only in the ratio that fill the phy- 
siological functions cense to perform their offices. But the usual habit* 
of living tend to thicken the fluids an' hasten these results premalure- 
\y — the fine capillary vessels of the delicate structure of the organs 
of sense become obstructed, and their functions impaired disproportion- 
ately to those of other and more vital organs. Hence the great fre- 
quency of deafness in old persons. We have no panacea to offer ii» 
this relation, of preventive or curative efficacy, save a life in conformity 
with the laws of life. 

Earache — Otalgia. — This is usually symptomatic of inflammation, 
or of foreign bodies or insects in the meatus. But the affection, con- 
sidered as idiopathic, is of a nervous, neuralgic, or rheumatic charac- 
ter, coming on abruptly, and disappearing suddenly, and is' unattended 
with febrile irritation. Noises in the ear, and slight deafness, are fre- 
quent accompaniments of otalgia. 

Treatment. — Fasting a day or two, syringing the ear with warm 
water, and a few tepid foot-baths, will generally soon remove the worst 
attacks. A warm or vapor bath, or a wet-sheet packing, will often re- 
move the trouble at once. If the stomach is foul, a warm water aine- 
tic should be employed, and if the bowels are not entirely free, copious 
warm water injections are advisable. 

Foreign Bodies anu Insects. — Children at play occasionally put 
beans, peas, small pebbles, and other substances into the ear-passage. 
These may remain an indefinite time without trouble; but frequently 
inflammation and ulceration ensue, with a constant discharge of irri- 
tating or fetid matter. They often produce the most intense agony, 
and are sometimes so surrounded by fungous growths as only to be de- 
tected by the most critical examination with the speculum, forceps, oi 
probe. If the body be hard, as a stone or metallic substance, the 
grating of the probe will discover it. 

Their removal by mechanical means requires the most careful and 
dextrous management, to avoid injuring the adjacent structures. 

Insects and worms sometimes effect a lodgment in the meatus, pro- 
ducing awful suffering. There is little doubt that inattention to clean- 
liness, particularly in diseased or ulcerated states of the passage, attracts 
the animals to deposit their ova there, which in time are converted into 
worms ; and it is possible they may be generated there as they are in 
a morbid condition of the secretions of the mucous membrane of the 



ERYTHEMATOUS INFLAMMATIONS. 



195 



stomach and bowels. In either case they are unprofitable and danger- 
ous residents. 

When they can be seen, they should be removed with the forceps. 
A pledget of lint, covered with some viscid substance, as oil and honey, 
to which worms when small and numerous will adhere, will often ena- 
ble us to remove them. They may be destroyed also by narcotic 
poisons, as oil of almonds, or a strong infusion of green tea, or tobacco. 



CHAPTER IX. 

ERYTHEMATOUS INFLAMMATIONS. 

In the loose, slip-shod medical literature of the day, the terms, ery- 
thematic, or erythematous, and erysipelatous^ are indiscriminately ap- 
plied to a great variety of topical, eruptive, and symptomatic inflam- 
matory affections, some of which are actually exanthems, or eruptive 
fevers, and others mere rashes, attended with little or no constitutionaJ 
febrile disturbance. In its strictest sense, erythema means inflamma- 
tory blush, and is applied to those external ma-nifestations of inflamma- 
tion which are not necessarily connected with fever ; whereas ery- 
sipelas is usually limited to an eruptive fever. Again, therefore, I find 
it necessary to sacrifice uniformity of method to convenience — my 
limits precluding the idea of a perfect nosological arrangement — and 
comprise, in the present chapter, 



Erythemas < 



(Edematous, 
Erysipelas, 
Gangrenous, 
Vesicular, 
Anatomical, 
Chilblain, 
I Fret. 



A Rash Exanthem — Nettlerash. 

o 

jj Icherous Exanthem < ' ' ' 
A i Pemphigus. 

a 

H Carbuncular Exanthem — Yaws. 



Erythemas. — All the varieties of erythema are characterized by 
red, tumid, fullness of the skin, disappearing on pressure, attended 
with a burning pain, and terminating generally in cuticular scales, or 
vesicles, sometimes in ulceration , and more rarely in gangrene. 

In the (edematous variety the skin exhibits a bright scarlet color; 
the affection spreads widely ant deeply through the areolar tissue, 



196 PATHOLOGY AND THERAPEUTICS. 



which often suppurates imperfectly, and occasionally sloughs and be- 
comes gangrenous. The swelling is principally caused by extravasated 
serum ; it is generally found in dropsical constitutions, and usually de- 
nominated, " (Edematous inflammation." 

In erysipelatous erythema the color is of a deeper red, and super- 
ficial, with a determinate edge, usually in a serpentine or winding di- 
rection, the part first attacked healing as the disease extends over the 
surface. This form is called " erysipelatous inflammation" in many 
medical books. Sometimes, though rarely, it is attended with some 
degree of extravasation, producing a soft swelling, and attended with 
a shining surface. It often follows wounds, injuries, and surgical ope- 
rations. In some cases it extends beneath the skin, and runs into sup- 
puration and mortification, constituting the erysipelas phlegmonodcs of 
Galen. 

Gangrenous erythema is characterized by a superficial dusky red 
color ; a bloody serum separates the cuticle from the true skin ; the 
cutis, when denuded, exhibits dark brown spots, which are disposed 
to blister and slough. It attacks chiefly the extremities. It is always 
found in extremely relaxed and debilitated constitutions, and is most 
common in advanced age, especially when the vitality has been pre- 
maturely exhausted by narcotics and stimulants, as tob_acco and alcohol. 
It is sometimes, however, seen in weakly infancy. Either of the pre- 
ceding varieties may pass into the gangrenous form. 

In the vesicular variety the color is pale red ; the surface is rough- 
ish, and covered with minute crowding vesicles, filled with acrid, often 
reddish fluid. Authors distinguish two sub-varieties : the first, benign, 
in which the vesicles advance without a breach of the cuticle ; and the 
second, corrosive, in which the vesicles break in the part first affected, 
and the corrosive fluid produces tracts of sanious ulceration as the red- 
ness advances. This and the preceding variety were called ignis 
sacer — holy fire— hy the ancients, from the superstitious notion that 
they were special inflictions of the Deity, or of His ministers. There 
are also sub-varieties of this form of erythema, produced by the me- 
dicinal administration of mercury and arsenic; the former has been 
called erythema mcrcuriale and hydrargyria in medical books. 

The anatomical variety is the erythematous inflammation, which 
arises from dissection. Unlike all the other forms of erythema, and, 
indeed, unlike most other inflammations originating from a local cause, it 
commences, at least in the great majority of cases, with a constitutional 
febrile disturbance ; the local affection first appearing about the shoul- 
der or axilla, while the injured part shows little or no inflammatory 
uction The characteristic symptoms, as well stated by Dr. Good, are : 



ERYTHEMATOUS INFLAMMATIONS. 197 



"Inflammation, wilh lancinating pains about the axilla, shooting down 
the chest, ushered by severe rigors and anxiety, succeeding rapidly to 
the dissection of a fresh corpse, with a puncture or abrasion of the 
hand of the anatomist ; blush, a deep crimson, with a spongy fullness, 
chiefly over the pectoral muscle ; fever, a typhus." Those few cases 
in which the local symptoms take the lead of the constitutional, are 
always the least dangerous ; and this remark probably holds true with 
every form of disease resulting from local injury or infection. 

The immediate cause of this affection has never been satisfactorily 
explained. It has been ascribed to a specific virus, to the irritation 
of a putrescent fluid, or to simple irritation or inflammation operating 
upon a peculiar idiosyncrasy, or constitutional habit. There is little 
doubt that a dead body, in the incipient stage of putrefaction, maj de- 
velop some chemical element, which, analogous to a ferment, is capable 
of inducing a process of transformation or decomposition in some of 
the elements of the blood, or other fluids of the body, not very dis- 
similiar to what happens in small-pox, measles, and other diseases 
dependent on a specific virus, or transformation of matter. To this 
view it has been objected that the disease is never taken from a corpse 
in the advanced stage of putrefaction ; but I think the objection itself 
furnishes a strong presumption of the correctness of the opinion ; for, 
it will readily be admitted, that all forms of matter which, in a particular 
stage of the process of decomposition develop an infectious or poisonous 
principle, must necessarily be changed into something different if the 
process of decomposition goes on. Thus yeast, the vaccine virus, and 
alcohol, all products of decomposition or putrefaction, may be resolved 
into very different and comparatively inert compounds of elementary 
matters, by further decomposition. 

The local inflammation and the accompanying fever resulting from 
the bite of venomous serpents — as the cobra de capello, and rattlesnake, 
from whose virus death often results within twenty-four hours — in all 
essential circumstances, resemble the erythema before us ; the chief 
difference being that the local and constitutional symptoms Loth com- 
mence and continue simultaneously, while the progress of the disease 
is much more rapid, the vitality being, as it were, destroyed as by an 
electric shock, by the first impression of the poison. 

There are also two classes of insects which occasion more or less 
local inflammation of an erythematic character, in some cases followed 
by a constitutional disturbance similar to that of anatomical erythema, 
and in a very few cases terminating in death. The. first class — as 
bees, wasps, hornets, ichneumons, etc. — sting, and the second class — 
as the gnat, horsefly, flea, bug, eto —pierce the skin and suck the 



198 



PATHOLOGY AND l II E R AP EU TIC S. 



blood. Whether the injury results mainly from poison, or the rritation 
of a rough, ragged wound, is not, in all cases, clear. The following 
cut exhibits the instrumentality by which these insects pierce, cut, and 
tear the fine capillary network of blood-vessels and nerves : 



Fig. 185. 




STINGING AND BITING INSECTS. 

In Fig. 185, a is a representation of the hornet; 6, the gnat; c, lancets of horsefly ; d, 
sting of wasp ; t lancet of flea ; /, lancets of bug. 

The variety called chilblain, or pernio, affects principally the hands 
and feet, and is occasioned by exposing the parts alternately to extreme 
cold and heat. In very cold climates the nose, ears, and lips are some- 
times destroyed by it. The skin is of a crimson color, suffused with 
blue, and is troubled with an excessive and obstinate itching. 

The remaining variety— fret, intertrigo, erosion of the skin — is gen- 
erally seen behind the ears of children, and about the groins and anus 
of children and adults. The inflamed part is of a bright red colo", the 
cuticle is eroded, und the exposed skin oozes a limpid and acrimonious 
fluid ; the discharge is often peculiarly offensive. The whole theory 
of its nature, advanced by Dr. Good, in his elaborate "Study of Med- 
icine," is in the following words : " It is an eiythema with weak vas- 
cular action, and often considerable irritability, in consequence of such 
weakness." The plain English of the matter is this. It is an eiythema 
with filthy personal habits, and always considerable uncleanliness of the 
skin us a consequence of such habits. I have never known a man, 



ERYTHEMATOUS INFLAMMATIONS. 199 

ffnmnn, or child who took a daily bath or wash over the whole surface, 
to be troubled witli it. 

Treatment. — In the first four forma of erythematic inflammation, we 
have to deal with local irritation, in connection with great general debil- 
ity; in the fifth-named variety these conditions are coupled with the 
peculiar morbid action of a specific virus; while in the last two varieties 
the only morbid condition is irritation. The indications of cure are, 
therefore, sufficiently obvious. 

(Edematous erythema is rarely found except as symptomatic of 
some primary malady; but when occurring idiopathicaliy, the local wet 
compress, frequently alternated with gentle friction by means of soft 
flannel or the bare hand, and the general tepid or cool ablution, or half- 
bath, constitute the leading remedial measures. Bandages of wet linen, 
when the absorbents are nearly powerless, and the accumulated fluid 
produces very painful distension, are frequently useful auxiliaries, pro- 
vided they are evenly and smoothly adjusted. 

From the facts that erysipelatous erythema frequently attacks chil- 
dren soon after birth, and that children are sometimes born with it, we 
may reasonably infer that the malady is closely allied to the voluntary- 
habits, especially the dietetic habits, of the patient, or, in case of infancy, 
the mother. Hence a strict and rigidly simple dietary is of first im- 
portance in the remedial course. The greater tendency to general 
fever requires more thorough general bathing, and frequently a resort 
to the wet-sheet pack. 

The gangrenous and vesicular forms require more particular atten- 
tion to the local treatment. While the general treatment is regulated 
by the superficial heat and the feelings of the patient, the temperature 
of the water being as cool or cold, but no colder, than is compatible 
with a prompt, and comfortable glow on the surface ; the local appli- 
cations should be very cold, so as to produce a tonic and constringing 
effect. If very cold applications are painful, they need not be contin- 
ued long at a time, but may be frequently repeated. 

Allopathic authorities have not yet settled the question whether the 
antiphlogistic plan — bleeding and reducing, or the stimulating plan — 
bark and wine — is the most proper; for neither claims to be successful. 
Messrs. Hutchinson and Lawrence, eminent European surgeons, rec- 
ommended making numerous and extensive incisions in the affected 
parts, with a view of arresting the disorganization of the structures; a 
practice which has been copied by several American practitioners, 
though not, I believe, with such success as will commend its general 
repetition. 

I am lot aware that any hydropathist has had an opportunity of tes*.- 



200 ' PATHOLOGY AND THERAPEUTICS. 

ing the new system in a case of erythema arising from dissection ; nor 
do I believe that all cases could be cured by hydropathic* or any other 
means. Some anatomists who become rt'is affected are among those 
whose physiological habits, especially in the matter of eating and drinking, 
are gross and unhealthful ; hence they may have that degree of putres- 
cency of blood which can offer but slight resistance to the destructive 
action of the infectious principle ; ac attack, therefore, may be certain 
death. And the same remarks apply to the bites of venomous serpents. 
But the most hopeful plan of treatment is clear. The intensity and 
malignancy of the disorganizing inflammation should be opposed by a 
succession of wet-sheet packs, sufficient to keep the morbid heat in 
check, and promote free perspiration, if possible. In a later stage of 
the disease, when the strength is much exhausted, and the extremities 
inclined to coldness, I would employ the warm wet-sheet, and apply hot 
bottles to the feet. Water-drinking should be insi3ted on to the full extent 
of the stomach's capacity to receive it without painful repletion. I am 
not aware that any advantage is pretended to have been derived from 
any of the numerous local applications which have been tried. In the 
erythema from the virus of serpents, a ligature above the injury, if 
applied immediately after the bite, or the removal of the wounded part 
by excision, or the actual cautery, when resorted to instantly, have no 
doubt many times materially abated the violence of the disease, or 
possibly have prevented it altogether. And in some instances it is said 
that sucking the poison from the wound very soon after the serpent's 
fang has been withdrawn, has prevented all injurious consequences — 
the mouth being defended by a wash of olive oil. It is exceedingly 
difficult to determine the value of these resources, for the reason that 
the majority who are bit are not poisoned at all ; hence a remedy per- 
fectly inert may acquire the reputation of a specific. It is worthy of 
remark, however, that the virus of the rattlesnake — and the same is true 
of the fetid secretion of the skunk, and, indeed, of the venomous 
matter of most, if not all, poisonous serpents, reptiles, and insects — is 
not dangerously noxious when taken into the mouth or even into the 
stomach in considerable quantities; indeed, it has been employed in 
one, two, and three deep doses as an antispasmodic, in difficult breath- 
ing, asthmatic affections, etc., its sensible operation being rather agree- 
able, nervine, and somewhat exhilarating, like the effect of castor, 
musk, and similar animal secretions. Compressing the vessels around 
the bitten part very soon after the accident by a cupping-glass or any 
similar instrument, by interrupting the process of absorption, may con- 
tribute something to the safety of the patient. The general treatment 
ifl, of course, precise'y the same, whether the system is poisoned from 



ERYTHEMATOUS INFLAMMATIONS. 201 

the regenerated virus of a dead corpse, or the venomous secretion of 
the living reptile. The irritation or poison resulting from the stings or 
bites of insects is most promptly relieved by the coldest water, and the 
preferable mode of application is the constant stream or douche. The 
constitutional affection, should it supervene, requires the same manage- 
ment as the anatomical variety. 

Chilblain requires a daily general bath or ablution, and frequent 
local bathing in the coldest water. As a prophylactic, the patient 
should never suddenly approach a hot fire when the feet and hands 
are very cold. 

The last named variety, as already intimated, only requires that the 
skin be well washed all over once a day, or oftener, with pure cold 
water. If there be any sufferers who cannot possibly be satisfied with- 
out some "medicated" wash, a small quantity of either bar or soft soap 
may be added to the water. Like all the empirical infullibles of the 
day, "it will do no harm, if it does no good." 

Nettle-Rash — Urticaria. — Some authors have treated of this 
disease as a variety of scarlet fever. The precursive fever is slight, 
although the stomach usually manifests considerable disorder. The 
rash appears about the second day, attended with a peculiar itching, 
like the sensation produced by nettle-stinging; the eruption wanders 
from part to part, and fades and revives irregularly. It terminates in 
a few days with cuticular desquamation. 

Special Causes. — Irritating, constipating, or indigestible food ; salt, 
vinegar, spices, narcotics, shell-fish, stale sausages, old cheese, frowzy 
butter, tainted animal flesh, etc. 

Treatment. — A warm water emetic, tepid injections daily to keep 
the bowels free, a daily dripping-sheet or half-bath, with plain and 
abstemious diet, are all that need be said on this subject. 

Aptha — Thrush. — This disease consists of minute vesicles, con- 
taining, when matured, a whitish or milky fluid. Authors distinguish 
three varieties: infantile, or while thrush, appearing in infants soon 
after birth, often extending from the mouth to the stomach, and even 
intestinal canal; the vesicles granular, i-oundish, and pearl-colored, and 
terminating in curd-like sloughs ; malignant, or black thrush, is seen 
most frequently as a symptomatic affection in typhus and malignant 
fevers ; but it is said to be sometimes found idiopathically in old age, 
and other exhausted states of the vital powers; the fever is a strongly- 
marked typhus, and the sloughs are dark-colored or 1 nek ; chronic 
tJirush is attended with great emaciation and hectic fever the eruption 



202 PATHOLOGY AND THERAPEUTICS. 

extends through the whole length of the alimentary canal, the edges 
of the tongue are affected with pimples, superficial blisters appear 
within the mouth and fauces, and the stomach is at all times troubled 
with a sense of heat and soreness. Diarrhea often attends, and ulcer- 
ations of the bowels are frequent consequences. 

Special Causes. — Hot drinks ; the excessive use of tea and coffee, 
especially the drug-colored green tea of commerce ; highly-seasoned 
food; confined air; repelled eruptions ; too concentrated food; rancid 
grease of any kind ; pork gravies; retained animal putrefaction, from 
inattention to bathing the skin, etc. 

Treatment. — The abdominal bandage, the wet-sheet pack once or 
twice a week, cool injections daily when diarrhea attends, moderate 
driuking of cool, but not very cold water, a daily half-bath, ablution, or 
dripping-sheet; and the adoption of a bland, simple, strictly vegetable 
diet, save the article of milk ; with a strict avoidance of all the producing 
causes, comprise the remedial plan. 

Pemphigus— Vesicular, or Bladdery Featr.— This affection is 
generally symptomatic of visceral inflammation ; though several nosol- 
ogists of celebrity describe it as an idiopathic disease, and even distin- 
guish it into several varieties. Its diagnosis is, transparent vesicles 
scattered over the body ; filbert-sized, with a red, inflamed edge, but 
without surrounding blush or tumefaction ; the vesicles contain a fluid 
which is pellucid or but slightly colored ; on breaking, the vesicles are 
disposed to ulcerate ; and the affection is accompanied with a fever - of 
the typhoid type. 

In the variety called vulgaris — common vesicular fever— the vesicles 
appear from the second to the fifth day, in successive crops, often ex- 
tending over the mouth and intestinal canal; another variety, called 
glandular, is preceded by swelling of the neck and throat, and in Switz- 
erland, where it has been chiefly noticed, it is considered as highly 
contagious ; and a third form, termed infantile vesicular fever, attacks 
infants soon after birth. 

Treatment.— As this disease, in its essential nature and causes, is 
nearly allied to the preceding, the treatment need not be materially 
different. In many cases, frequent sponging with tepid water is suf- 
ficient. M. Langhaus, who has given us a description of the gland- 
ular pemphigus of Switzerland, and who treated the disease by bleed- 
ing and sweating, tells us, with a self-stultification peculiar to the school 
to which he belonged, in one part of his narrative, that "it was so 
contagious as to spread with great rapidity through numerous families, 
and so malignant, that all persons affected by it die( " and yet, in allu- 



ERYTHEMATOUS INFLAMMATIONS. 203 

sion to his bleeding and sweating, recommends it, " with the most san- 
guine hope that it will effect a speedy cure." 

Yaws. — Rubula and J'rambossia are other terms by which this dis- 
ease is known. Some nosologists have classed it among the eruptive 
fevers, although the attending fever is merely adventitious ; while oth- 
ers have regarded it as properly belonging to the order of tumors. It 
resembles syphilis and other infectious diseases, in being communicable 
by contact; and the exanthems and contagious diseases, in rendering 
the body nvulnerable to a second attack. 

Symptoms.— -The disease consists of numerous and successive tu- 
mors, commencing with mere specks, and gradually increasing to the 
size of a raspberry, which they somewhat resemble ; some of the 
smaller papula? become real pustules, and discharge an opake, whitish 
fluid when broken, and concrete into dense scabs or crusts; the larger 
run into fungous excrescences, and in their granular surface, as well as 
size and color, resemble the raspberry, from which their name is de- 
rived. These tumors, one of which becomes, at length, much larger 
than any of the rest, have but little sensibility, suppurate very imper- 
fectly, and discharge a sordid, icherous matter. They originate in 
scattered groups over the body, and their connection with personal un- 
cleanliness and infection is sufficiently evinced by the fact, that they 
are chiefly found in the groins, axillae, about the anus and pudenda, 
though they often disfigure the neck and face. 

This is one of the most unsightly diseases known ; and nothing can 
exceed the revolting spectacle of a West India yaw-house, where the 
slaves, suffering under this disease, are collected together. Dr. Good 
has distinguished the disease into two varieties — African and Ameri- 
can. The diversity of the symptoms, however, is slight, and attribut- 
able wholly to local circumstances. In duration the disease varies from 
one to three months. Sometimes callous tumors are formed on the 
soles of the feet, in consequence of the yaw-tubercles not being able 
to press through the thick skin ; these are called lubba, or crab-yaws, 
and greatly impede the exercise of walking. 

Treatment. — One or two tepid or moderately cold general baths, 
either by the dripping-sheet, pack, or ablution, with a strictly vegetable 
and rigidly simple and abstemious diet, are the prorer therapeutic 
appliances. 



204 



PATHOLOGY AND THERAPEUTICS. 



Spasm 



Suffocative 
Spasm 



CHAPTER X. 

SPASMODIC DISEASES. 

There are a variety of diseases, whose most prominent phenomena 
are : irregular muscular contractions, in some cases amounting to a 
more or less permanent rigidity of particular muscles, and in others 
attended with convulsive agitation of some part or of the whole mus- 
cular system. These may be conveniently grouped in thu present 
chapter in the following manner : 

^ ( Convulsion, 

Comatose I ' 

Spasm <! L P ile P s y> 
L Hysterics. 

(Tremor, 
Delirium Tremens, 
Synclonic 1 Shaking Palsy, 

St. Vitus' Dance, 

Raphania, 

Barbiers. 

Cough, 

Dyspnoea, 

Asthma. 

Laryngismus, 

Incubus, 

Bronchitis, 

Sternalgia, 

Pleuralgia, . 

The generic distinctions in the above arrangement may be thus 
defined : The comatose spasm is attended with muscular agitation, 
diminished sensibility, inability of utterance, followed by a tendency to 
drowsiness; the synclonic spasm is characterized by a simultaneous 
trembling, or chronic agitation of various sets of muscles, especially 
when excited by the will; the suffocative spasm disturbs, momentarily 
or permanently, the muscles of respiration alone ; the clonic spasm is 
the forcible excitation of one or more muscles in sudden and irregular 
snatches ; and the constrictive spasm is an irregular form of muscular 
contraction producing rigidity. 





' Hiccough, 




Sneezing, 


Clonic 


Palpitation, 


Spasm 


Nictitation, 




Subsultus, 




Stretching. 




Hydrophobia. 




Acrotismus, 




Tetanus, 




Locked-Jaw 


Constrictive 
Spasm 


Cramp, 


Muscular Spina! 




Distortion, 




Muscular Stiff- 




Joint. 




Wry Neck. 



Convulsion. — Deaths from convulsion-fits, especially nmong the 



SPASMODIC DISEASES. 205 

infantile population of our country, are becoming alarmingly frequent. 
In the city of New York its fatality ranks next to that from consump- 
tion, and is all the while increasing, and as far as I have been able to 
gather information on the subject, the same is true of nearly all parts 
of the United States. Why twenty or thirty children, all of them not 
far from two or three years of age, should die weekly the year round, 
in this city, from this disease, may well engage the earnest thoughts 
of philanthropists and physicians, and, above all, of mothers. 

Although convulsion occasionally attacks persons in all periods of life, 
the disease, as already intimated, is conspicuously frequent and fatal in 
infancy; pregnant women are also, after the sixth month, during labor, 
and immediately afterward, liablo to the disease then denominated 
puerperal convulsions. 

Symptoms. — The muscula» agitations are violent, and with very 
young children the spasmodic movements are extremely rapid; the 
fingers work, and the eyelids quiver; the teeth gnash; sometimes the 
convulsive motions skip from one part to another; at other times the 
body is universally convulsed; occasionally the paroxysms intermit and 
recur at irregular intervals ; often they are accompanied with shrieks 
or yells. In infancy, the disease is usually preceded by twitchings and 
startings, and accompanied with a blueness about the eyes and upper 
lip. "When it occurs in adults, the muscles are powerfully exercised, 
the mouth foams, the eyelids open and shut perpetually, or are 
stretched upon a full stare, while the protuberant eyeball rolls rapidly 
in every direction, and the whole face is hideously distorted. 

Special Causes. — In the course of this work I have more than once 
had occasion to allude to the unhealthful habits and fashions which 
prevail in fashionable, and, indeed, in nearly all civilized society, in the 
matter of rearing children. The disease before us is one of the many 
special evidences of the general bad feeding, bad dressing, bad doctor- 
ing, and bad management that rule in the nursery; and as especially 
prominent among the special causes may be named concentrated food 
and confections — bakers bread, sweet-cakes, candies, etc. — and the 
paregoric and purgatives which are given to silence the pain and 
remove the constipation which they produce. 

Treatment. — The first thing to be done in a convulsion-fit is to 
expose the patient to abundance of cool air and plenty of cold water. 
There is no danger from any amount of ventilation in the coldest of 
weather while the fit continues. The cold ablution, or dripping-sheet, 
will answer for bathing purposes, but the half-bath, during which the 
surface is actively rubbed with the bare hand, is the preferable mode. 
As the bowels are usually clogged with ill-digested matters, or irritated 
18 



20G PATHOLOGY AND THERAPEUTICS. 

by acrimonious secretions, tepid injections should not be omitted. After 
the spasms are overcome, the prophylactics to employ in the intervals 
are brown home-made bread, and milk, potatoes, squashes, pumpkins, 
apples, etc., and a daily bath or universal wash-down. 

Epilepsy — Falling-S ^kness. — Epileptic fits present all degrees 
of violence, from a slight general spasmodic agitation and distortion 
of the muscles of the face, with a momentary suspension of conscious- 
ness, succeeded by a sense of drowsiness or stupor scarcely apprecia- 
ble, to the most violent convulsive movements of the face and chest, 
while the limbs are fixed and rigid, and followed by several hours of 
total unconsciousness. 

Symptoms. — In some instances the disease is ushered in by precursive 
symptoms, which warn the patient of the approaching attack. The 
most usual of these is a sensation of a cold creeping vapor from some 
particular part of the body, which has been called an aura epileptica. 
But more generally the paroxysm comes on suddenly, and often com- 
mences with a -startling scream; the patient is instantly deprived of al. 
sense of perception and power of motion, and if standing, he falls, 
while the body is more or less convulsed ; the muscles of the face 
and eyes are always much affected, and the countenance violently 
distorted; the tongue generally protrudes from the mouth, which dis- 
charges a frothy saliva; the lower jaw is strongly convulsed, and the 
teeth, gnashing upon the tongue, often wound it severely; sometimes 
the urine and foeces are discharged involuntarily. A profound lethargic 
sleep succeeds the severer attacks, from which the patient at length 
awakes, unconscious of having suffered pain. 

When the disease is owing to an organic cause, the attack is more 
abrupt ; the patient suddenly falls prostrate ; there is more rigidity and 
less spasmodic agitation of the muscles, and optical illusions are very 
common. This form of epilepsy has been called falling-sickness, or 
cerebral epilepsy. 

Special Causes. — Among the organic causes are various structural 
derangements, as misformation of the head, externa] injuries, interna) 
tumors or collections of matter. When the disease is functional, the 
causes which specially excite the paroxysm in the individual predisposed 
to it, are — strong mental emotions, especially of the depressing kind, aa 
anger, grief, fright ; indigestible food, an overloaded stomach, or any 
source of gastric irritation, may prove an exciting cause ; repelled 
eruptions, and the sudden suppression of customary evacuations, have 
induced it ; exhausting indulgences, either in the exercise of the lower 
inimal propensities, or in the use of stimulants and narcotics, frequently 



SPASMODIC )ISEASES. 20J 

occasion an attack ; confirmed drunkards are pecu] ally liable to it ; in 
a few instances the disease ha« arisen from worms. 

Prognosis. — The chance of cure will be favorable or unfavorable 
as the symptoms do or do not indicate functional derangement or local 
irritation as the cause. When connected with deficiency or malform- 
ation of brain, organic changes, or exhausted nervous power, it is gen 
orally, and probably always, incurable. 

Treatment. — During the fit very little can be done, on account of 
the muscular distortions. Cold water, however, should be freely 
applied to the head, cold compresses to the stomach, and warm appli- 
cations to the feet. In the intervals, the cure must be prosecuted by 
a careful attention to the general health ; and here we have another 
condition where the dietetic part of hydropathy is more important than 
the watery, although both are useful. So utterly powerless for good, 
if not mischievous, has the drug-treatment proved in this disease, that 
one of the most experienced of the old school authors, Dr. Armstrong, 
testifies that he has seen more benefit derived from removing the excit- 
ing cause, than from any thing else. " As to diet," his language is, 
"simplicity in the kind of food, and moderation in its quantity, is the 
golden rule." In making the practical application of this golden rule, 
we should prescribe the dry diet as crusts of good brown bread, roasted 
potatoes, and good baked or boiled apples, as the leading articles. 
Caution must be exercised not to distend the stomach unduly with a 
variety at a meal, of even the blandest articles; very little drink should 
be taken at meals, and the supper should be extremely light, or what 
is better, altogether omitted. Among the bathing processes, derivative 
appliances — shallow-baths, sitz-baths, and foot-baths — should take the 
lead. As a general rule, they should be of short duration, and fre- 
quently repeated, so as to guard against determination to the brain. 
If the skin evinces considerable torpor or obstruction, the patient 
should be thoroughly rubbed in the dripping-sheet, or packed occa- 
1 sionally. 

Hysterics — Hysteria. — This disease is commonly supposed to be 
peculiar to the female ; but some authors, having noticed all its charac- 
teristic symptoms occasionally in the male subject, have described two 
varieties — hysteria feminini, and hysteria masculini. It is certainly 
more frequent in the female, and most disposed to show itself during 
the menstrual period. 

Symptoms. — The preenrsive signs, which, however, do not always 
exist, are — a sense of nausea or sickness, flatulency, palpitation, de- 
pression of spirits, weeping, crying, etc., without any assignable cause. 



208 PATHOLOGY AND THERAPEUTICS. 

The fit soon follows, indicated by a coldness or shivering over the whole 
body; quick, fluttering pulse; a feeling of acute pain in the head, as 
though a nail were driven into it ; there is often an acute sense of pain 
in the left side, about the flexure of the colon, with a sense of disten- 
sion, giving the idea of a ball or globe rolling itself about in the abdo- 
men, and gradually advancing upward till it gets into the stomach, 
whence, rising to the throat, it occasions a sense of suffocation, as if 
an extraneous body were pressing there; this feeling has been called 
globus hystericus. The convulsive struggle now commences, which is 
Bometimes extremely violent; the trunk of the body is twisted back- 
Ward and forward, the limbs are variously agitated, the fists are firmly 
clenched, the breast is spasmodically beaten, the muscles of the chest 
are agitated in every way, and the patient bursts into-violent paroxysms 
of laughter, sobbing, or screaming, utters incoherent expressions, and 
is in a state of temporary delirium. On the cessation of the spasms, 
there are flatulent eructations, and a copious discharge of limpid urine, 
the patient usually lies stupid, and apparently almost lifeless, for a short 
time, but in an hour or so recovers the exercise of sense and motion, 
without retaining any distinct recollection of what has taken place, but 
feeling a severe pain in the head, and a general soreness over the 
whole body. 

Diagnosis. — Hysteria may be distinguished from epilepsy by the 
insensibility being only partial ; by the sighing and sobbing respiration ; 
by the globus hystericus; by a peculiar trembling of the eyelid ; and 
by the absence of distortion of the features. In a milder and modified 
form, the paroxysm consists of sudden insensibility, laborious breathing, 
swollen neck, flushed cheeks, and a closed and trembling eyelid, and 
the patient comes out of the fit talking incoherently, or crying and 
sobbing. 

Special Causes. — Intense mental emotions, especially grief and anx- 
iety; constipated bowels; excessive evacuations; obstructed menses; 
plethora; hot, enervating drinks, as tea and coffee. 

Treatment.— A hysterical paroxysm is almost the only disease in the 
treatment of which allopathic and hydropathic prtctitioners harmonize. 
It is true the books recommend smelling-salts, nsafoetida, fetid spirits 
of ammonia, ether, castor, musk, valerian, skunk-cabbage, opium, etc., 
yet the same book-makers are kind enough to tell us they do no good ! 
Says Dr. Guy, author of a Medical Jurisprudence: "Cold affusion is 
the only remedy which can be relied on, and is worth a whole phar- 
macopoeia of antispasmodics." Drs. Hooper, Good, Cooper, Neill. 
Smith, and Copland — all accredited authors of the drug school rec- 
ommend the cold-water pract : ?e. Avd Dr. Alfrod Smee, F.R S., 



SPASMODIC DISEASES. 



209 



surgeon to the Bank of England, etc., gives the following directions, 
illustrated by a plate, both of which aro worth copying : 

Fig. 186. / 




itmnAfl 

TREATMENT OF HYSTERI 4 

"Place the head over a basin, and pour water from a jug over the 
head and chest till the patient becomes chilly and revives. Never use 
any thing but cold water for the hysterical fit, unless the party turn 
very cold, when you should discontinue it, and apply warmth to the 
feet. I once saw the cold applied for three hours, but the patient was 
quite well the next day." 

To correct the condition on which the hysterical paroxysms depend, 
we must, during their intervals, employ the abdominal bandage, fre- 
quent hip-baths, and occasional dripping-sheets or packs. In almost 
all cases the bowels are more or less constipated, and the diet must be 
regulated accordingly. 

Tremor — Trembling. — A tremulous agitation of the head, limbs, 
or both, especially on some voluntary exertion, often occurs in the pro- 
gress of acute and chronic diseases. But in some instances the 
affection appears disconnected, as far as we can observe, with any dis- 
tinct primary disease, although it is manifestly in all cases symptomatic 
of nervous exhaustion. It is produced by violent exertion, vehement 
indulgence of the mental or sexual passions, by various poisons, as mer- 
cury, lead, opium, tea, tobacco, and is ouly to be cured by religiously 
and perseveringly abstaining from all the debilitating causes which con- 
duce to it ; in brief, all the voluntary habits must be thoroughly ortho- 
therapeutic. 

Delirium Tremens — Drpxkakd's Delirium. — "This disease," 



210 PATHOLOGY AND THERAPEUTICS. 



says Dr. Donne, "is unfortunately very frequent in the United States;" 
to which may be added, that hardly a day passes without some suicide 
or murder being chronicled in the newspapers as committed under its 
influence ; nor can any different result be expected, so long as our law- 
making representatives authorize and commission by special license, 
one class of our fellow citizens tc poison all the other classes by selling 
them intoxicating drinks. 

Symptoms. — Delirium, during whiijh the patient recognizes those 
about him, answers questions rationally, and does hurriedly what, he is 
told to do ; the hands, lips, and muscles generally, tremble more or less, 
especially when speaking, or making any voluntary effort; the patient is 
restless, sleepless, talks incessantly, and evinces a great anxiety to be 
doing something ; he fancies that he is surrounded with enemies, or 
that he is in a'Strange place, from which he is constantly endeavoring 
to escape; or he thinks some great evil has befallen him, or is impend- 
ing; he is suspicious of those about him, and is tormented with fright- 
ful images or sounds ; and often appears to be searching earnestly in 
unlikely places after something on which his mind is intent. There is 
frequently profuse perspiration, a frequent pulse, and a moist and 
slightly furred tongue. In the most dangerous attacks the patient is 
himself not violent ; but in more moderate cases, when the muscular 
energies are Ies3 prostrated, he is sometimes extremely furious. 

Special Causes. — The habitual employment of alcoholic beverages 
in most cases; in a few instances the disease has arisen from the use 
of opium, tobacco, and tea. The immediate exciting cause is generally 
sudden abstinence from the accustomed stimulant, particularly if such 
abstinence has been preceded by an unusual debauch. 

Treatment. — When the patient is not ungovernable the wet-sheet 
pack is the most soothing process we can employ; in other cases we 
must rely mairiiy on the tepid shallow-bath, accompanied with active 
and persevering friction ; the dripping-sheet is also one of the best ap- 
pliances when considerable feverish heat exists. When the stomach 
is foul, evinced by bilious taste and fetid breath, a warm water emetic 
is useful, or even the copious drinking of warm water without emesis; 
and a daily tepid injection is almost always serviceable. Cold cloths 
should be applied to the head, and when there is the least indication 
to coldness of the feet, the warm foot-bath should be prescribed. Ei- 
ther of the general baths may be repeated two or three times daily, or 
all of them may be alternated. When the patient is too irritable or 
restless to permit any general bath to be employed in the ordinary 
way, wet towels may be applied to the chest, abdomen, and thighs, and 
frequently renewed; and copious cold water injections may be^hrown 



SPASMODIC DISEASES. 211 



up the bowels. In all cases cold water may be drank to any extent 
the thirst demands. 

In re'alion to drug-treatment in this disease, the allopathic school is 
about, equal)} 7 divided between large doses of opium and liberal draughts 
of brandy. Dr. Johnson, in his "Domestic Hydropathy," tells us that 
the only way to cure the disease is to procure sleep ; and that there is 
no way of procuring sleep but by means of large doses of opium ; but 
the doctor climaxes his own climax of absurdity when he adds that, 
although the opium induces a sleep, which cures the delirium tremens, 
the patients often die in the sleep which the opium induces ! 

Shaking Palsy. — Paralysis Agitans. — The term palsy, is not 
strictly applicable to this disease, for the reason that, although there is 
a diminution of muscular strength and of voluntary power in the part 
affected, there is no absolute loss of muscular motion, nor of sensation, 
one of which, or both conditions, being always present in genuine pa- 
ralysis. 

Symptoms. — " Permanent agitation of the head or limbs without vol- 
untary excitement ; body bent forward, with a propensity to run and 
fall headlong; usually appearing after maturity." The first spnptoms 
usually noticed are a slight sense of weakness with a proneness to trem- 
bling, commonly in the hands and arms, but sometimes in the head. 
These increase gradually and almost imperceptibly, until, in a few 
months, the legs begin to be similarly affected, and the body bends for- 
ward. As the disease progresses, the tremor becomes constant anj 
universal ; the muscles refuse to act in obedience to the will ; and, 
should the tremulous agitation be stopped in one limb' by a sudden 
change of posture, it soon makes its appearance in another. When 
he attempts to walk he is thrown on his toes and forepart of his feet, 
and thus compelled to adopt a running pace. In the advanced stages 
the tremulous motions also occur during sleep ; the bowels become tor- 
pid, mastication and deglutition are difficult, and the saliva continually 
dribbles from the mouth. Toward the closing scene, the power of 
articulation is lost, the ordinary evacuations are involuntary, and coma 
with slight delirium occurs. 

Special Causes. — Long exposure to damp, unwholesome vapors, 
nervine excitants, as ardent spirits, strong tea or coffee, narcotic poi- 
sons, as tobacco, nightshade, etc. ; metallic vapors, especially mercurial ; 
drastic purgatives. Those who are employed in mines, and hence 
constantly exposed to the exhalations of mineral vapors, are the most 
frequent and severe sufferers from this disease. 

Treatment. — As the proximate cause is simple debility of the whole 



212 PATHOLOGY AND THERAPEUTICS 

nervous system, the simple indication of cure is to strengthen the sys- 
tem ; the only point of skill is in adapting the processes to the particu- 
lar condition of the patient. The best general plan is, a daily ablution, 
or thorough rubbing in the dripping sheet, early in the morning, one 
or two shallow or hip-baths in course of the day, followed by active 
friction with the dry sheet or dry hand; and where the system has 
been evidently poisoned with metallic emanations, moderate sweating, 
either in the wet or dry sheet, as often as twice a week. Cold water 
should be drank rather freely, and cold injections employed daily, just 
preceding the time when the bowels are or should be evacuated. The 
wet girdle to the abdomen is worth something. The food should be 
of the most bland and unconcentrated kind, as cracked wheat, dry 
brown bread, hominy, potatoes, baked, boiled, or uncooked apple9, etc. 
Nothing can be more obvious than the nature of this affection ; and 
nothing can be more ridiculous than the reasoning on the subject in 
medical books, nor more absurd than the practice recommended. Thus 
Bonet ascribes the affection to a diseased state of some portion of the 
cerebrum ; and Mr. Parkinson fixes the seat of the disease in the cer- 
vical portion of the spinal marrow, from which he supposes it to shoot 
up by degrees to the medulla oblongata! "The remedial process," 
says Dr. Good, " is not very plainly indicated ; " yet he recommends 
vesicatories and other stimulants to the neck ; setoyis, causties, and 
even the red hot iron applied to different parts of the spine ; and for 
internal remedies, prussic acid and arsenic ! ! Dr. Elliotson treated 
several cases with copious bleeding, blisters, mercury, setons, zinc, and 
sub-carbonate of iron ; but save in a single instance, no benefit whatever 
was experienced. Such is a fair specimen of the " medical science" 
of the day. 

Chorea — St. Vitus's Dance — Chorea Sancti Viti. — This dis- 
ease is characterized by "alternately tremulous and jerking motion of 
the face, legs, and arms, especially when voluntarily called into action, 
resembling the grimaces and gestures of buffoons." The name of St. 
Vitus's Dance— in colloquial French, Dance de St. Guy — according 
to Horstius, was given to this affection, or some other resembling it, in 
consequence of the reputed cures produced on certain women of dis- 
ordered mind, upon their visiting the chapel of St. Vitus, near Ulm, 
and dancing from morning till night, or until completely exhausted. 
Many marvelous stories are related of these dancers by the old writers, 
some of whom, in their easy credulity, give the patients credit for hav- 
ing danced a whole week or whole month together. 

Symptoms — The disease appears most frequently from tho eighth to 



SPASMODIC DISEASES. 213 

the fourteenth yeur; and attacks boys and girls indiscriminately, but 
chiefly those of weak or impaired constitutions. Its approaches are 
slow, and are marked by variable and often ravenous appetite, loss of 
usual vivacity, swelling and hardness of the lower belly, and, in gene- 
ral, constipated bowels, which symptom becomes aggravated as the 
disease advances; slight, irregular, involuntary motions of different 
muscles, particularly those of the face, precede the more violent con- 
vulsive agitation. The convulsive motions present a great variety of 
appearances. The muscles of the extremities, of the face, those mov- 
ing the lower jaw, the head, and the trunk of the body, are each at 
different times, and in different degrees affected ; the patient walks un- 
steadily, his gait resembling starlings or jumpings ; and sometimes walk- 
ing is impossible. The agitation of the muscles is constant during the 
day, but ceases during sleep. The eye eventually loses its lustre, the 
complexion becomes pale, and the countenance is expressive of languor 
and vacancy, giving the patient afatuitous appearance. 

Special Causes. — Repelled eruptions ; lead ; mercury ; constipation ; 
narcotics; worms. Dr. Good remarks, "The predisponent cause of 
this disease is an irritability of the nervous system, chiefly dependent 
upon debility, and particularly a debility of the stomach and its collati- 
tious organs." The passage is certainly very fine, but if it has any par- 
ticular meaning I am unable to discover it. Dr. Armstrong gives us a 
less eloquent but more practical view of the subject. "Chorea," says 
he, " is always preceded by some disorder of the stomach, liver, or 
bowels ; and the affection which takes place in the brain and spinal cord 
seems to be secondary. You may always trace its rise to some im- 
proper diet." 

Treatment. — The whole plan of medication named in the preceding 
disease is applicable here. The great majority of cases, however, will 
be found in connection with torpid liver, costive bowels, and obstructed 
skin ; for which a thorough daily ablution, an injection every day, or 
every other day, and a diet of brown bread, wheaten grits, potatoes, 
and a moderate quantity of the best fruit, wiL' ^e sufficient. 

Raphania. — This disease was first descmied by Linnseus, and so 
named because he supposed it to arise from eating the seeds of a spe- 
cies of wild radish, the raphania raphanistrum. Other writers have 
imputed it to spurred rye or ergot, and others to still other vegetable 
poisons. The symptoms indicate the operation of a uarcotic; and 
probably several plants, and perhaps also different vegetables in a state 
of disease or decay, or in a particular stage of putrefaction, may gen- 
erate the poisonous element. 



214 PATHOLOGY AND THERAPEUTICS. 



Symptoms. — The disease commences with cold chills and lassitude, 
headache, and anxiety about the praecordia; these are followed by 
spasmodic twitching, and afterward rigid contraction of the limbs or 
joints, with excruciating pains, often Accompanied with fever, coma, or 
delirium, a sense of suffocation, and a d.fficulty of articulation. It con- 
tinues from one to four weeks, and when fatal, terminates with a 
diarrhea, or convulsive paroxysm. 

Treatment. — Moderate cold water-drinking, the free employment 
of cold water injections, the wet-sheet pack daily, or twice a day. 
when there is considerable feverishness, and at other times frequent 
tepid ablutions, constitute the leadiug measures of the curative plan. 

Note, — An anomalous disease has, during the last ten years, prevailed 
in different parts of this country, more frequently in our Western 
states, to which the physicians have been unable to assign a name, and 
which strikingly resembles the disease before us. If it is not identical 
so far as its causes are concerned, it is sufficiently similar in character 
to be appropriately treated on the same plan. 

Barbiers— Beribery. — This affection is probably unknown in this 
country. It is common to various parts of India, and of very frequent 
occurrence in Ceylon, and on the Malabar coast. 

Symptoms. — General lassitude, painful numbness of the whole body, 
stiffness of the legs and thighs, and a spasmodic retraction of the 
knees, and inability to walk, are among the early symptoms. In some 
cases the limbs are paralytic, and spasmodic actions affect irregularly 
the muscles of the body, chest, and larynx. In a later period of the 
disease, the legs swell, and subsequently the whole body becomes 
bloated and oedematous, the internal cavities are filled with fluid, and, 
in fatal cases, extreme difficulty of breathing, great restlessness, intol- 
erable anxiety, constant vomiting, and general convulsions, close the 
scene. 

Special Causes. — Sudden transitions from a dry to a damp atmos- 
phere, and from sultry calms to chilling breezes, are assigned, by 
medical writers, as the principal causes. But as the subjects of its 
attack are almost invariably persons of weakly constitutions, irregular 
lives, debauched habits, or liquor and tobacco topers, and above twenty 
years of age, it is evident that the causes named are only exciting cir- 
cumstances, when tho constitution is predisposed by debility, or the 
bad habits which cause the debility. 

Treatment.— Pl. daily ablution and hnlf-bath, plain food, regulated 
exercise, according to the strength, and cold injections, would seem 
adapted to the therapeutic indication, which is essentially tonic. 



S P A S M J D I C D I S E A S B S. 215 



Cough. — There are three kinds of cough which me ranked as idio- 
pathic diseases by authors — common cough, dry cough, and hooping- 
cough. They are all attended with a sonorous and violent expulsion of 
air from the lungs, from a spasmodic or convulsive action of the respi- 
ratory muscles; the first and second varieties are often symptomatic 
of a multiplicity of other diseases. 

Symptoms. — Common cough, or humid covgh, is accompanied with 
nn expectoration of a mucous or serous fluid. The dry cough is so 
called because it is unattended with expectoration. In the hooping- 
cough — kin-cough, pertussis — it is accompanied with a shrill, reiterated 
hoop; vomiting is also a frequent incident. The last variety is conta- 
gious under certain circumstances, which are not very well ascertained. 
The disease comes on with the usual symptoms of catarrh; the excre- 
tion is always viscid, though small in quantity at first. The hoop, or 
sonorous spasm, is frequently violent, the face becoming turgid and 
purple from suffusion, and the eyeballs swollen and prominent. The 
paroxysms at first recur several times during the day, are most violent 
toward evening, and least so during the night. After the disease has 
continued some time, they return only in the morning and evening, 
and toward the end of the disease in the evening only. The violence 
of the disease varies from the slightest iudisposition without feverish- 
ness, to the severest spasmodic agitation, attended with high and dan- 
gerous fever. Its duration varies from one week to one year, the usual 
period ranging from three weeks to three months. The pathognomonic 
sign of the hooping-cough is the noisy inspiration accompanied by a 
lengthened hissing. It is generally a disease of children, and the 
danger is in the inverse ratio to the age. 

Special Causes. — The first and second varieties are produced by 
"colds," or the inhalation of irritating dust, vapors, or other extraneous 
particles. The third is the result of specific contagion. 

Sequela. — Bronchial inflammation, consumption, and dropsy in the 
head, are commonly specified in medical books as among the sequela? 
of all forms of cough, but more especially of the hooping kind. They 
are more commonly the sequelae of the poisonous cough mixtures with 
which children are generally so liberally fed. 

Treatment. — All forms of idiopathic cough may be very easily man- 
aged. Cold water should be freely drank ; the diet must be plain and 
rather abstemious; and one or two ablutions daily, followed by thorough 
friction or active exercise, are, in 'the majority of cases, amply reme- 
dial. When the system is inclined to feverishness, the pack, prolonged 
sufficiently to produce moderate sweating, may be necessary ; and 
when there is an inflammatory state or fixed soreness of any part of 



216. PATHOLOGY AND THERAPEUTICS. 



the chest or lungs, the chest-wrapper should be applied. When the 
paroxysms of hooping-cough are very severe and suffocative, a warm 
water emetic is advisable ; and in bad cases a tepid half-bath and foot- 
bath should be added to the daily processes. 

The allopathic treatment of cough affords a melancholy reflection for 
the intelligent philanthropist. How many little children are poisoned out 
of their constitutions by the multitudinous cough-medicines of the day! 
It is true the regular doctors declaim against the irregular nostrums, 
by which children are poisoned through the media of lozenges, medi- 
cated candies, and narcotic syrups ; but unfortunately their own pre- 
scriptions are not a whit less poisonous. The most deadly drugs of the 
materia medica are the active principles of nearly all the popular cough 
remedies, and chief among them all are tartar emetic and opium; while 
henbane, deadly nightshade, poison hemlo<*k, and prussic acid, are in 
the next highest class of remedies ! 

Di'spncea. — The generic symptoms of this disease — the anhelation 
of Dr. Good — are : permanent difficulty of breathing, with a sense of 
weight in the chest. Like cough, dyspnoea is symptomatic of an ex- 
tensive range of diseases. 

Symptoms. — Idiopathic difficulty of breathing is distinguished into 
two varieties, chronic, and exacerbating — the orthopnaa of authoi's. In 
the former the breathing is uniformly short and heavy, and usually 
accompanied with a cough; in the latter it is deep, stertorous, and suf- 
focative, subject to sudden and irregular exacerbations, and relieved by 
an erect position. 

Diagnosis. — Dyspnoea is distinguished from asthma by the breathing 
being permanently yet irregularly affected; whereas in asthma the 
difficulty is recurrent with considerable intervals of perfect ease. 

Special Causes. — Irritating dust, or pulverulent particles to which 
stone-hewers, glass-cutters, china-manufacturers, workers upon metals, 
millers, starch-makers, horn and pearl-workers, weavers, wool-carders, 
and feather-dressers, etc., are subject; the vapor of mineral acids, 
metallic exhalations, narcotic vapors, various structural derangements, 
as corpulency or obesity, hydatids, tumors, indurations, adhesions, etc. 
In some instances, a condition of emphysema, or preternatural dilatatien 
of the air-cells of the lubgs, resulting from catarrh, has produced both 
dyspnoea and asthma. 

Treatment. — When the cause is -organic, little more can be done 
than to mitigate the sufferings of the patient by a careful attention to 
the general health. When the disease depends on functional derange- 
ment, the general management is the same as for common cou°h. A 



SPASMODIC DISEASES 217 

moderate douche to the spinal column would be of additional service in 
most cases by promoting absorption ; and where patients have been 
exposed to poisonous vapors or effluvia, moderate sweating is desirable 
Sauvages relates the case of a female who was bled three times a day, 
until the venesections amounted to two thousand, without benefit ! By 
warm bathing and active friction, so as to produce free perspiration 
she was cured in ten days. 

Asthma. — This affection is, too, much more frequently a symptom- 
atic than an idiopathic affection. Its pathognomonic characteristics are : 
recurrent and temp6rary difficulty of breathing, accompanied with a 
wheezing sound, and sense of constriction in the throat, with cough 
and expectoration. Authors distinguish two varieties, dry, convulsive, 
or nervous — asthma siccum; and humid, or common — asthma humidum. 

Symptoms. — In the first variety the attacks are sudden, violent, and 
of short duration; the sense of constriction is hard, dry, and spasmodic; 
cough slight, expectoration scanty, and only appearing toward the end 
of the paroxysm. In the second variety the paroxysm is gradual and 
protracted ; the constriction heavy, laborious, and humid ; cough vio- 
lent; the expectoration commences early, is at first scanty and viscid, 
but afterward copious, and affording great relief. In many cases the 
attack is in the night, and most frequently an hour or two after mid- 
night. 

Special Causes.— Nearly all the causes named in the preceding dis- 
ease may produce this. It is frequently caused by rurgescence, or 
swelling of the liver or spleen, which impedes the motions of the dia- 
phragm, or interrupts the supply of nervous influence. Strong mental 
emotions, repelled eruptions, suppressed discharges, rank odors, foggy, 
misty, or damp weather, indigestible food, and other dietetic errors, are 
frequent exciting causes. The predisposition is sometimes occasioned 
by malformation of the chest, small size of the glottis, dyspepsia, all 
of which may be conditions of hereditary transmission. Dr. S. Cooper 
names among the occasional causes, "the influence of light and dark- 
ness" — an idea altogether too diffuse. 

Treatment. — Medical authors admit that asthma is seldom cured 
drugopathically, yet console themselves with the reflection that patients 
seldom die of the disease, as such, or until it takes some other form ; 
hence an opportunity is afforded to try any kind of medication that 
fact or fancy can suggest. It is true that expectorants and nauseants, 
as squills and antimony, and relaxants and debilitants, as tobacco, coffee, 
gin, saltpetre, and bleeding, generally relieve the paroxysm for the 
time, at the expense, if frequently repeated, of the total ruin of the 

rr— is 



218 PATHOLOGY AND THERAPEUTICS. 

digestive powers and nervous system ; and that emetics, especially of 
lobelia, have entirely suspended the symptoms of the disease in the 
humid variety, for a longer or shorter period, without any great injury 
to the constitution ; and this, I believe, is all that can be said in favor 
of the popular practice. 

The rubbing wet-sheet, pack, and douche, with the chest-wrapper, 
are the leading processes. Any of the other bathing appliances may 
be useful or necessary in particular cases, but these are applicable and 
important in the great majority. When the digestive organs are 
strongly implicated, the tepid shallow-bath is excellent, and then the 
abdominal bandage may be substituted for the chest-wrapper. Asth- 
matic patients can usually take three or four baths daily with advantage. 
The following combination I have employed successfully in several 
cases : Dripping-sheet five minutes, followed by the douche three min- 
utes, on rising; at ten to eleven a.m., wet-sheet pack forty-five to sixty 
minutes, followed by shallow-bath at 72°, ten minutes ; at four p.m., 
sitz-bath at 65°, fifteen to twenty minutes, or shallow foot-bath at 65°, 
five to ten minutes. Where there is a good degree of animal heat, a 
dripping-sheet, at bed-time is very serviceable. The bowels must be 
kept free, by tepid or cool injections, if necessary, and the patient 
may generally drink six or eight tumblers of water in the forepart of 
the day. Equally important, and perhaps more so, is the diet. Here 
we have another opportunity to magnify "the hunger-cure." In all 
cases the diet should be simple and unconcentrated, and in those cases 
connected with or caused by diseased livers or spleens, or primary 
dyspepsia, it must be rigidly abstemious; and even this should be com- 
posed principally of the articles named in a former part of this work 
under the head of dry diet, or something similar. 

During the paroxysm we should palliate and abbreviate the sufferings 
of the patient as much as possible, by exposing him freely to the cold 
air — which is, indeed, what his feelings most intensely desire, and 
which is always safe while the fit is violent — giving him warm water to 
drink, even to the extent of vomition, and applying the warm half or 
hip-bath ; or when the breathing is so laborious that he is obliged to 
sit erect, the hot fomentation to the chest and abdomen. 

Laryngismus — Laryngismus Stridulus. — This complaint is 
known by the various synonyms of spasmodic croup, spasmodic asthma 
of children, child-crowing, crowing inspiration, angina stridula. 

Symptoms. — The disease consists essentially of a sense of spasmodic 
suffocation in the larynx, which usually comes on suddenly in the night, 
attended with a struggle for breath, anl a shrill, croaking sound of the 



SPASMODIC DISEASES 21? 



voice, or crowing inspiration, somewhat analogous to .-roup ; the coun- 
tenance is flushed and swollen, and in the severest cases convulsions 
occur. Dr. Good names " troublesome cough," as among the pathog- 
nomonic symptoms, while Hooper says it is "unattended by cough." 
The symptom in controversy is merely incidental. This disease some- 
times, though rarely, attacks adults. 

Diagnosis. — It is distinguished from croup by the attack being more 
sudden, and the symptoms relaxing or intermitting ; the freedom of 
the breathing during the intervals ; the absence of febrile or catarrhal 
symptoms ; and usually the presence of hot swollen gums. 

Special Causes. — Repelled eruptions, especially of the head, face, or 
neck; intestinal irritation from worms ; indigestible aliment ; enlarge- 
ment of the glands of the neck and chest ; cold, and teething are some- 
times exciting causes. An oedematous swelling of the mucous folds in 
the ventricles of the larynx, has been supposed by some authors to be 
the proximate condition on which this affection depends. 

Treatment. — The ordinary drug-treatment is, an antiinonial emetic, 
a calomel cathartic, an opium anti-spasmodic, and a Spanish-fly vesica- 
tory — a plan of medication far more dangerous than the disease itself. 
Several folds of wet-cloths well covered with dry to the throat, a tepid 
bath followed by the dry pack, or by putting the patient in bed, well 
covered so as to promote perspiration, free warm water-drinking, and a 
tepid injection if the bowels are not entirely free, is the plan of a safe 
and successful treatment. 

Incubus. — Authors distinguish two varieties of incubus, one of which 
is called nightmare, and the other daymare. The ancient Anglo-Saxon 
name for this affection was elf- squatting — eij sidenne — so denominated 
because of the imaginary resemblance of the sudden sense of an op- 
pressive and suffocative weight on the chest, to the feeling produced by 
some hideous monster lying on the chest. 

Symptoms. — Both varieties are attended with sighing, suffocative 
difficulty of breathing, intercepted utterance, or entire temporary ina- 
bility to speak or move, with a sensation of some external weight press- 
ing heavily o** the chest, from which the patient awakens affrighted. In 
the daymare, which occurs during wakefulness, the sense of pressure 
is severe, and is extended over the abdomen ; the respiration is fre- 
quent, laborious, and constricted ; the eyes are fixed ; the sighing is 
deep and violent; and the intellect is undisturbed. The nightmare it 
the more common form ; it occurs during sleep, which is interrupted 
with a violent struggle and tremor; the pressure on the chest seems 
to be that of some hideous monster or phantom ; it is usually preceded 



220 PATHOLOGY AND THERAPEUTICS. 

by a painful or troubled dream, during which the patient imagine* some 
position of danger, as a high building, steeple, or precipice, from which 
he is about to fall ; or fancies some horrid accident or calamity, as mur- 
der or suicide, or conceives an attack from some enemy, hag, spectre, 
ghost, or goblin, whose grasp he is incapable of eluding. 

Special Causes. — It is generally occasioned by excessive fatigue, ex- 
haustion from want of sleep, an overloaded stomach, or some indigesti- 
ble irritant in the alimentary canal. Dyspeptics, and nervous females 
are very liable to it. All persons who eat heavy or late suppers are in 
a state of predisposition. 

Treatment. — Shaking, agitating, or awakening the patient will imme- 
diately arrest the paroxysm, which, by the way, seldom lasts a full 
minute. The preventive management is found in alight evening meal, 
a hard bed, and sleeping on rather high pillows, with the body a little 
inclined on the side. The curative plan may be found in a daily bath, 
plain quality and moderate quantity of food, and a free daily action of 
the bowels, which should be promoted by injections if necessary. 

Bronchitis. — Although this disease is attended with more or less 
suffocation and spasmodic respiration, it is really caused by, or rather 
is in fact, an inflammatory affection of the mucous membrane of the 
bronchial ramifications. It is frequently the precursive condition of 
consumption ; and not unfrequently the treatment pursued by the med- 
ical man, rapidly hastens on the fatal termination, by developing tuber- 
cles in the lungs. It is comparatively a modern disease, and is alarm- 
ingly on the increase, owing to the luxurious and enervating habits of 
fashionable society. 

Authors distinguish the disease into the acute and the chronic forms; 
but as the former is not essentially different from a severe catarrh, or 
mild pneumonia, either in its symptoms, progress, or termination, it is 
only what is usualry known as chronic bronchitis that concerns us here. 
Irritative and inflammatory affections of the mucous membrane of the 
throat, fauces, larynx, pharynx, and adjacent parts, are often confounded 
with bronchitis proper : and are described as and confounded with this 
disease under the various terms of pulmonic erysipelas,- pituilous ca- 
tarrh, bronchial angina, suffocative catarrh, catarrhal bronchitis, bron- 
chial peripneumony, pulmonary catarrh, catarrhal fever, acute mucous 
catarrh, acute svffocative catarrh, etc. 

Symptoms.— -The disease commences with more or Jess couarh irri- 
tation about the throat, sense of tightness in the c'lesr ™,j JL \ 
of breath, which do nof , f or . confidemble time ^J,t 1°?°" 
*>*• T Jle fi ,t difficu , y which „ genera]Iy noti ; -- J-J-JJ. 






SPASMODIC DISEASES. 221 

is a sense of roughness, with frequent attempts to clenr the throat, ac- 
companied with or followed by titillation of the larynx, exciting a dry, 
hard cough ; these are, after a longer or shorter period, succeeded by 
some degree of hoarseness of voice, with a sense of tightness across 
the chest, and sometimes a slight pain or diffused soreness upon cough- 
ing, or inflating the lungs fully by a prolonged and deep inspiration. As 
the disease progresses dyspnoea comes on, which is increased by exer- 
tion, coughing, or exposure to cold, and some degree of expectoratiou 
occurs, at first scanty, then more copious and of a glairy appearance, 
like the white of an egg ; and in still more advanced stages it becomes 
muco-purulent or purulent and sometimes tinged with blood. In some 
cases ali of the symptoms are abated every summer and exacerbated 
every winter for several years in succession. The constitutional dis- 
turbance is marked by lassitude, pains in the limbs and back, slight shiv- 
erings or chills, frequent and feeble pulse, feverishness after dinner or 
toward evening, and eventually night sweats. In some cases the prin- 
cipal local symptoms are, hoarseness or loss of voice, a hard, dry cough, 
with a sense of soreness, rawness, dryness, and heat under the ster- 
num ; in most cases the cough is always excited by a full inspiration ; 
in a few instances the breathing is rattling or wheezing, owing to the 
air struggling through the viscid mucus accumulations in the bronchi ; 
and sometimes, though rarely, the voice is scarcely altered, while the 
breathing, on the slightest disturbing causes, become* painfully spas- 
modic, in consequence of the tenacious, glaring secretion becoming con- 
creted upon the lining membrane of the bronchial tubes. 

Special Causes. — All the causes of consumption, may, under a mod- 
ified set of circumstances, produce this form of pulmonary disease. 
But there is no doubt that the increasing quantity of tea, coffee, and 
tobacco consumed by our people is a special cause of the increasing 
prevalence of this disease among us. 

Treatment. — Nearly all that has been said in relation to the man- 
agement for consumptives will apply here ; and to that the reader is 
referred. A majority of the patients come to us bundled up in flan- 
nels, extra silk, double stockings, India rubbers, and other contrivances 
for keeping off the cold, to which these very contrivanceb — usually per 
advice of the doctor — have rendei-ed them extremely susceptible. All 
these Avorse than superfluities of dress must be removed by degrees, as 
the parent's skin becomes accustomed to the contact of cold air and 
water. The best processes to commence with are generally the sponge 
or towel-bath, or rubbing-sheet, accompanied with active though not 
severe friction. After a few days the chest-wrapper should be applied, 
end all the derivative appliances — half, hip and foot-baths — employed, 



PATHOLOGY AND THERAPEUTICS. 



as frequently and as cold as the patient can bear without . g 
ble or prolonged chilliness. Precaution is necessary also, 
greatly disturbing the circulation or respiration, by too great a shock 
or too cold an impression. When the general heat of the surface is 
equal to, or above the natural standard, the pack should be resorted to 
daily, or tri-weekly- Those patients who are particularly troubled 
with' short bre«th, and are easily fatigued by exercise, should walk 
regularly and perseveringly in the open air, within the bounds of much 
fatigue at first, and gradually increase the distance. 

At best bronchitis is a dangerous and most obstinate disease, and pa- 
tents ought to understand before commencing a course of water-treat- 
ment, that time and patience are important considerations. I have 
known a few cases recover in ten or twelve weeks, but a majority re- 
quire careful treatment from six to twelve months, while many cases 
cannot be thoroughly cured in less time than from one to two years. 
This may seem like a long and discouraging process; but if the sufferer 
can draw any consolation from the fact that no other method ever cures 
al all, he will find abundant evidence of the fact if he will look over the 
long catalogue of remedies which are put forward in medical books ; a 
list whose formidable length is alone conclusive that no real confidence 
is fell in anyone of its ingredients, nor in all together. 

Perhaps a page or two of this work could not be more instructively 
occupied than in presenting a fair sample of the interminably experi- 
mental nature of drug-treatment — as few unprofessional persons have 
ever dreamed of the confusion which pervades medical books on the 
subject of prescribing remedies. As an illustration, therefore, I will 
copy in full, from one standard work— Copland's Medical Dictionary- 
all nnd singular the remedies and curative processes, commended for 
the treatment of the different states, forms, stages, and complications of 
the disease under consideration. These may be conveniently collated 
under the heads of classes, processes, fumes and fumigations, inhala- 
tions, drugs and preparations, and regimenal directions. 

1. Classes of Medicines. — Acids, alkalies, emetics, purgatives, expectorants, laxatives, 
tonics, refrigerants, stimulants, antipblogi6tics, demulcents, cathartics, emollients, rube- 
facients, mucilages, vesicatories, revulsants, counter-irritants, diaphoretics, diuretics, se- 
datives, bitters, alteratives, attenuants, antispasmodics, narcotics, diluents, enemata, ano- 
dynes, and narcotics. 

2. Processes of Medication. — General bleeding by the lancet; local bleeding by leeches • 
topical depletion by cupping; lancing the gums (in children) ; blisters applj,.,) to TBr i on , 
parts ; burning the skin by hot turpentine ; cauterizing the sliin by moxa burnings • 
tulating the skin by ointment of tartarized antimony ; leeches applied over the sT ' 
leeches applied behind the ears ; leeches applied below the occiput ; cupuin^ H ' 

of the neck ; issues ; sctons the warm-bath ; sponging the body with warm w„ Jl ""?" 
egar ; sponging with a warn lotion of nitro » uriatic acid ; astringent « i Vm " 

= gargies ; cooling 



SPAS. IODIC DISEASES. 223 

gargles ; antiseptic gargles ; demulcent linctuses ; lotions of common salt and water; semi- 
cupium ; pedik:iivium ; poultices; liniments; and fomentations. 

3. Fumes and Fumigations. — Of tar, camphor, benzoin, amber, frankincense, myrrh, 
Btorax, cloves, sulphur, assafoetida, and various turpentines and balsams ; also the smok- 
ing of balsam of tolu. 

4. Inhalations. — Of chlorine gas ; fumes of iodine ; watery vapor holding in solution 
various narcotics ; sulphuret of iodine ; liquor potassii iodidi concern tratus ; tinctures 
and extracts of henbane and poison hemlock, with camphor; fumes of the various bal- 
sams, terebinthinates, and odoriferous resins ; also of vinegar. 

5. Drugs and Drug- preparations. — Antimony in full doses ; antimonial wine ; com- 
pound powder of antimony ; tartrate of antimony and potassa ; solution of potassio tar- 
trate of antimony ; James' powder ; blue pill ; calomel ; corrosive sublimate ; mercury 
with chalk and rhubarb, followed by castor oil and small doses of ipecacuanha; Dover's 
powder ; wine of ipecacuanha ; opium ; camphorated tincture of opium ; syrup of pop- 
pies ; camphor ; camphor mixture ; ammonia ; carbonate of ammonia ; liquor of the ace- 
tate of ammonia ; conserve of roses ; capsicum ; olive oil ; white willow bark ; Iceland 
moss; Fruesic acid ; aloes ; senna ; creasote ; preparations of steel ; carbonate of soda; 
bi-carbonate of soda ; bi-tartrate of potash ; compound tragacanth powder ; sulphur ; bal- 
sam of sulphur ; sulphuret of potassium ; sulphuric acid ; sulphuret of ammonia ; sul- 
phuret of copper ; sulphate of zinc ; sulphate of quinine ; sulphate of alumina ; flowers of 
Bulphur ; sulphate of iron ; various preparations of iodine ; extract of dandelion ; extract 
of hops ; extract of conium ; extract of hyoscyamus ; extract of sarsaparilla ; extract 
of gentian ; extract of poppy ; extract of lettuce ; belladona ; trisnitrate of bismuth ; salt- 
petre ; squills ; decoction of squills ; tincture of squills ; infusion of squills ; oxymel of 
squills ; tincture of hyoscyamus ; culcbicum ; infusion of colchicum seeds ; digitalis ; 
chlorate of potash ; tartrate of potash ; chlorate of lime ; columbo ; decoction of Peruvian 
bark; infusion ofmarrabium; chloride of calcium ; liquorice; mczeron bark; cinchona; 
uva ursi ; gum arabic ; oil of turpentine ; myrrh ; vinegar ; marsh mallows ; decoction of 
polygala ; linseed tea ; ammoniacum ; galbanum ; senega ; nitrous spirit of ether ; kermes 
mineral ; mixture of sweet almonds ; and syrup of tolu. 

Regimenal Directions. — Barley water; tamarind water; lemonade; vegetable acids ; 
sulphureous mineral waters ; Brandish's alkaline solution ; ale ; beer ; imperial ; red 
wines of Bordeaux and Burgundy ; decoction of Iceland moss ; jellies ; mucilaginous and 
emolient soups ; new-laid raw egas ; shell-fish ; and white fish, dressed with olive oil, or 
the oil obtained by boiling their own livers. 

There, reader, you have the whole apothecary shop and most of its 
appurtenances before you. I submit whether these evidences of cure 
do not prove too much? 

Before dismissing this subject, I must advert to the cauterizing prac- 
tice which has lately become so popular in bronchial and throat affec- 
tions. Some physicians are doing an extensive business in the appli- 
cation of nitrate of silver to all sorts of affections of the mouth and 
throat; and some kind of machinery has recently been invented by 
which the dust of lunar caustic can be inhaled into the lungs. It is 
fcrae that caustics will often cure ulcers in the mouth, or about the 
fauces or tonsils ; but they are very liable to reappear, and, moreover, 
thev can be better cured without the caustic than with it. But where 
the lungs are seriously affected, or the bronchial ramifications in a state 
of actual inflammation, the application of the caustic very frequently 
Aggravates the affection of the pulmonary tissues, as I have known in 



224 PATHOLOGY AND THERAPEUTICS. 

very many cases. This practice may be safe in purely local affections 
of the throat, but it is certainly hazardous where the lungs are also 
implicated. 

Sternalgia — Suffocative Breast-Pang. — This affection is de- 
scribed by various writers under the varied names of angina pectoris, 
syncope anginosa, orthopnea cardiaca, arthritic, or dolorous asthma, 
and sternocardia. 

Symptoms. — The disease is characterized by a violent pain about the 
sternum, or breast-bone, extending toward the arms, attended with 
anxiety, difficulty of breathing, and a sense of suffocation. Authors 
describe two varieties : acute, in which the attack comes on suddenly 
during exercise, with a tendency to faint, and which is relieved by 
rest ; and chronic, in which the paroxysm is less violent, of longer 
duration, recurring frequently, and excited by slight causes, attended 
with palpitation, and not relieved by rest. 

Special Causes. — Corpulent, gouty, rheumatic, and debilitated per- 
sons are especially the subjects of its attacks; hence the usual causes 
of obstruction and nervous exhaustion may be regarded as its predis- 
posing influences, and, indeed, it is always symptomatic of some gen- 
eral morbid condition. Laennec regarded angina pectoris as a species 
of neuralgia of the heart ; and some authors have imputed it to ossifi- 
cation of the coronary arteries of the heart — a supposition purely 
fanciful. 

Treatment.- — The paroxysms can be relieved by a warm water 
emetic, a dripping-sheet or douche, or the pouring head-bath. The 
cure depends on a well-regulated diet, and a daily cold-bath. 

Pleuralgia — Pleurodyne. — Both of these terms import pain in 
the side, and are employed to denote a pungent pain in the side, with 
difficulty of breathing, which difficulty is owing to an acute distress or 
ache produced by every attempt to inflate the lungs. It is distinguished 
from pleurisy or pneumonia by being unattended with fever or inflam- 
matory symptoms. 

Symptoms. — In the acute or severe form, which is called stitch in 
the side, the pain is sudden and temporary, supervening on exercise, 
and being relieved by repose. In the chronic form the pain is per- 
manent, augmented by pressure, and there is inability of lying on the 
side affected. 

Special Causes. — The first variety is generally occasioned by hard 
running, jumping, lifting, or other violent exertion, but is sometimes 
symptomatic of flatulence hysteria, hypochondriasis, ore. The second 






SPASMODIC DISEASES. 225 



variety is in some cases symptomatic of structural derangements, as 
aneurism, malformations, adhesions, or other organic lesions; more 
commonly it is caused by plethora, transferred gout or rheumatism, 
chronic inflammation of the liver or spleen ; and more frequently still 
it is produced by the barbarous custom of lacing the chest, and the 
mischievous habit of leaning against a hard desk, or bending the trunk 
of the body forward while writing, reading, sitting, sewing, etc. 

Treatment. — The stitch gradually subsides on moderating the exer- 
cise, or by resting. It may be promptly relieved by a handkerchief, or 
tight bandage, the hot fomentation, or warm douche. In the chronic 
form we must have regard to the producing cause, or the primary 
malady. The abdominal girdle is, however, always in order. 

Hydrophobia — Canine Madness— Rabies — Entasia Ltssa.— 
Hydrophobia literally means water-dread, a symptom which generally, 
though not uniformly, attends the disease, and is, in some instances, 
found in other diseases. 

Symptoms. — The disease generally commences with pain, uneasi- 
ness, or some unusual sensation in the wound, or bitten part, followed 
by pains darting along the course of the nerves. But in some few 
cases these local symptoms do not appear. The first constitutional 
symptoms are, wandering pains in different parts of the body; stiffness 
of the neck and throat; restlessness and irritability; the patient is 
drowsy or depressed; he is observed to sigh deeply and frequently; a 
principal feature among the early symptoms is a sudden and deep in- 
spiration with which the patient is frequently affected. He is also 
severely agitated by the impression of cold air, the glare of a mirror, 
the noise of a pump, the sound of water, etc. As the disease pro- 
gresses, its true nature becomes revealed by the difficulty of swallow- 
ing liquids, which increases until the sight or sound of water causes 
him to start with dread and horror; the attempt at deglutition is hur- 
ried, accompanied with sobbing, and followed by convulsions. The 
countenance now expresses indescribable alarm, anxiety, and suspicion ; 
the eyebrows are contracted ; the eyes are wild, staring, and glassy ; 
there are urgent thirst, hot and dry skin, painful efforts to vomit, and 
intolerance to light and sound. The sufferer spits out the frothy mucus 
and viscid saliva between his closed teeth, with vehement strainings, 
which occasion a singular sound ; talks in a loud, important, authoritative 
tone, and often screams violently. In some instances the intellect seems 
unaffected to the last, but in other cases he is wildly delirious, and 
talks incoherently and incessantly. Toward the end, convulsions be- 
come more frequent, ar.d the patient dies asphyxiated or exhausted 



22G PATHOLOGY AND THERAPEUTICS. 

The duration of the disease is usually two or three days ; in some 
rare instances it has continued eight or nine days. The symptoms also 
manifest considerable diversity. Sometimes the wounded part exhibits 
nothing more than a slight lividity, and sometimes the cicatrix opens 
afresh, and oozes forth a little colored serum. In some cases tho 
patient is furiously mad, 1 ; tes himself and others, also the bedclothes, 
and whatever else is withi J reach. 

Special Causes. — This disease is usually communicated by the bite 
of a rabid animal ; but it may originate spontaneously. The nature 
and origin of the virus, or infecting principle, are unknown. But that 
putrid flesh and decomposing offal, on which so many dogs, cats, hogs, 
etc., are fed, are the chief producing causes, is attested by the fre- 
quency of its occurrence in those animals. But this cause alone does not 
seem capable of generating the poison. Some excitement, or feverish 
heat of the blood, must cn-operate. It is well known that violent 
passions have, in the human being, and in various domestic animals, 
changed the saliva in a moment to an absolute virus, which has com- 
municated disease and death to others. Thus the bite of an enraged 
man, horse, hog, goose, duck, and hen, has been known to impart a 
deathful infection. And when a furious exercise of the passions, or an 
inflammatory state of the blood by violent exercise, co-operates with 
putrescent food, the peculiar abnormal transformation of matter may 
take place, which, analogous to a ferment, as I have previously had 
occasion to intimate, may produce in the saliva a virus capable of 
propagating itself under favorable circumstances. This view is cor- 
roborated by all its historical and phenomenal data. Dogs, cats, and 
hogs are most exposed to these combined influences, and these animals 
are most subject to the disease, and in the order named. Wolves and 
foxes have been noticed as more frequently affected than the herbivora 
— h«rses, oxen, cows, sheep, goats, etc., and the manner in which they 
are exercised and fed, still strengthens our position. 

Prognosis.— Hooper pronounces judgment in the following words : 
"Fatal. The disease has hitherto defied all remedies." Some few 
cases, however, have recovered under different and even opposite 
plans of treatment, owing probably to the enduring energies of a good 
constitution. Water-treatment has apparently succeeded in two or 
three instances. 

Latent Period. — The time which elapses between the bite of the 
rabid animal and the development of the symptoms, is usually from 
twenty to forty days; but it may be less than a week, and has been 
Known to extend to three and four years. 

Treatment. — The indications are — 1 T > equa.' ; ze the distribution of 



SPASMODIC DISEASES. 227 

Eervous influence; 2. To deterge the system of its virus. In the 
early stages the cold treatment may be applied in almost any form, 
provided it be powerful enough to produce a decided sedative influence 
upon the whole system, followed by the wet-sheet or dry blanket en- 
veloping, to promote perspiration. Probably the preferable processes 
are the douche and rubbing-sheet, followed by the wet-sheet pack 
when the temperature of the body is nearly at or above the normal 
standard, and by the dry pack when the circulation is low, and there 
is an inclination to chilliness. These processes may be repeated and 
alternated as long as the spasmodic condition of the throat exists. 
Meanwhile, if the patient cannot swallow sip« of cold water, he may 
perhaps be able to chew or swallow bits of ice ; and he may be in- 
dulged to the extent of his inclination. Very cold compresses or pow- 
dered ice should also be applied to the thorax. Very cold water enemas 
I should decidedly recommend, although I am not aware that they 
have ever been tried. Hooper tells us that the irritation of the throat 
has never been removed except by the use of ice taken internally. 

Priessnitz has repeatedly cured rabid dogs by douching them perse- 
veringly in cold water. The following case, treated by Dr. Todd, at 
King's College Hospital, is instructive : The patient was a boy seven 
years of age, laboring under the worst form of the malady, and refus- 
ing, with horror and impatience, every thing offered him, of either a 
solid or liquid form. After having taken twenty drop doses of prussic 
acid without any effect on the spasms, he was offered a fragment of 
rough ice, which he seized and swallowed with avidity. Fresh pieces 
were constantly put into his mouth, which he seized and craunched 
between his teeth with remarkable eagerness, swallowing them with 
perfect ease. In half an hour he had taken a pound and a half of 
rough ice; and at. the same time a bladder containing a mixture of 
roughly-powdered ice and common salt was applied the whole Jfngth 
of the spine and around the throat. Under this treatment all the 
symptoms referable to the throat and chest, with the exception of oc- 
casional hackings, passed away, and nothing remained but extreme 
restlessness, violent excitement, and incoherence. In this condition, 
nnd in Dr. Todd's absence, the cold douche was unfortunately applied 
by the directions of some other physicians, "but the system," says the 
physician who prescribed the douche, " did not rally from the shock." 
Dr. Guy, author of a work on Medical Jurisprudence, remarks, in 
relation to the above case: "I am inclined to attribute more benefit to 
the internal than to the external use of ice in this case ; but the joint 
administration seems to be the nost rational treatment yet recom- 
mended." 



228 PATHOLOGY AND THERAPEUTICS. 

There was certainly a grave mistake in the application of the cold 
douche under the circumstances. On the first attack it would have 
been proper, but when the violent symptoms are subdued by cold 
treatment, and the patient is in a state of partial collapse, a very cold 
shock is entirely out of place. But there is another very important 
consideration. The patient had taken' enormous quantities of a pow- 
erful narcotic, and, although he did not manifest any symptoms of nar- 
cosis while the convulsive paroxysms continued, yet the deadly drug 
was in him, and must have so paralyzed the nervous system that it 
could not possibly react or rally against such a shock, which, in an 
earlier stage, or without the prussic acid, might have been harmless 
and salutary. Patients will, in no diseases, and under no circumstances, 
bear cold shocks as well while under the influence of narcotics; a fact 
I have repeatedly known to be verified in actual practice. The history 
before us shows also the danger of occupying the system, and prostrat- 
ing its energies by'a drug-poison, while we are making impressions oo 
the system by another and very different set of agencies. They do 
not work well together. 

The cold water-treatment was in repute for hydrophobia even in the 
days of Celsus ; and Dr. Good, who, after an elaborate examination 
of all the methods of treatment known to, or rather practiced by mod- 
ern physicians, confesses the utter inutility of all of them, adverts to the 
case of a patient who was cured by water, as though it was a wonderful 
escape from death by drowning. "Thus," says Dr. Good, "M. Morin 
relates the case of a young woman, twenty years of age, who, laboring 
under symptoms of hydrophobia, was plunged into a tub of water with 
a bushel of salt dissolved in if, and was harassed with repeated dippings 
until she became insensible, and was at the point of death, when she 
was still left in the tub, sitting against its sides. In this state, we are 
told, she was at length fortunate enough to recover her senses, when, 
much to her own astonishment, as well as to that of the bystanders, 
she found herself capable of looking at the water, and even of drinking 
it without choking." 

The preventive treatment after the bite, as in all cases of poisoned 
wounds, is by excision of the part, if it can be done instantaneously ; 
the ligature; cauterization; suction; and perhaps refrigeration. Prob- 
ably the immediate application of a ligature above the bitten part, and 
the employment of a powerful cupping-glass over the wound, would 
arrest the process of absorption for an hour or two, after which excision 
or cauterization may be resorted to, or both. In all cases, it would be a 
prudential measure, after the wound has been attended to, to undergo 
a thorough course of wet-slpet packings, with the view of cleansinjj 



SPASMODIC DISEASES. 229 

'he body as much as possible from all morbid secretions or putrescent 
ticcumulations upon which the virus could, as it were, feed and prop- 
agate itself, should any portion of it happen to pass into the circulation. 

Acrotismus. — The affection called acrolism, pulselessness, and by 
some asphyxia, though improperly, is a failure or cessation of pulsation 
for a longer or shorter period, sometimes affecting only particular parts 
of the system, and sometimes extending over the whole body, often 
accompanied with paleness, chilliness, pain in the epigastrium, and a' 
sense of spasmodic constriction in the respiratory muscles. 

It is often precursive of palsy and apoplexy, sometimes symptomatic 
of organic derangements ; but is sometimes puoduced by functional de- 
rangement of the stomach, liver, or spleen, or some obstruction to the 
equable radiation of the nervous energy. Some persons have possess- 
ed the ability to produce, by voluntary effort, a universal deficiency of 
pulsation, and of simulating natural death. 

Treatment. — The paroxysm may be relieved by thorough friction 
with cold wet cloths, followed by dry flannel or the dry hand ; the cure, 
so far as practicable, depends on a strict compliance with all the laws 
of hygiene. 

Tetanus. — Several forms in which this disease presents itself, have 
been designated as varieties by many authors ; as emprosthotonos, when 
the body is bent rigidly forward ; pleurosthotonos, when it is rigidly 
bent laterally ; episthotonos. when rigidly bent backward ; erectus, when 
rigidly erect, etc. 

Symptoms. — The character of the disease is a permanent and rigid 
contraction of many or of all the voluntary muscles, with incurvation 
of the body, and difficulty of breathing. Generally the extremities are 
firmly extended, the abdominal muscles strongly retracted, the eyes 
fixed, the forehead drawn up into furrows, and the whole countenance 
is shockingly distorted ; the violent contractions are attended with ex- 
cruciating pain ; the pulse is accelerated ; the respiration is very la- 
oorious, or almost suspended.: and the skin is covered with a profuse 
perspiration. The symptoms frequently remit partially, but are re- 
newed with aggravated torture by the slightest cause, as the least motion 
of the patient or slightest touch of an attendant. Sometimes the tongue 
is darted spasmodically out of the mouth, and the teeth, spasmodically 
snapping upon it, lacerate it severely, unless prevented by some in- 
tervening substance. In fatal cases, death is preceded by frothv or 
bloody mucus at the mouth, small and imperceptible pulse, and de- 
lirium. 

-.20 



230 PATHOLOGY AND THERAPEUTICS. 

Special Causes. — Sudden exposure to damp and cold when the body 
is overheated; wounds, punctures, lacerations, or other local irritations 
of nerves; the bad air of crowded hospitals ; extreme terror, or violent 
passion ; sympathy ; long exposure to a very hot sun ; various narcot- 
ics, as strychnine, or nux vomica ; intense galvanic excitement. Hoop- 
er names, among the predisposing causes, " the male sex, robust and 
vigorous constitutions, warm climates, the period of infancy !" It is a 
singular reflection on nature, or on nature's God, that one cannot be a 
male, nor have a good constitution, nor live in a warm climate, nor ex- 
ist during infancy, without being, from either of these circumstances, 
predisposed to tetanus. 

Duration. — In fatal cases the ordinary duration is from four to eight 
days. Favorable cases linger from one to eight or ten weeks. 

Prognosis. — When arising from wounds, the disease has in most 
cases proved fatal, and it is exceedingly dangerous when existing from 
any cause. 

Treatment. — Water-Cure has not yet been fairly tested in this for- 
midable affection, but the principle upon which the treatment should be 
regulated, seems very clear. The single indication is to abate the irri- 
tation ; and to do this the leading measures must be calculated to pro- 
duce and maintain a relaxant or sedative effect. Horses, and even 
Wounded soldiers, have been cured by an accidental exposure to a long 
and drenching rain; from which fact we may derive a profitable hint- 
As the patient is excessively susceptible to impressions of all kinds, it 
would not answer to weaken him with very warm water, nor shock him 
with very cold. The wet-sheet envelop — and two or three thicknesses, 
are better than one, especially in the early stage, if the patient has taken 
little or no narcotic or depleting remedies — offers the best resource. As 
soon as the patient is comfortably warm, a part of the bedding should be 
removed or the bed-clothes loosed, so as to keep up a comfortable glow 
imd maintain a moist state of skin for a long time, even hours together. 
When the patient becomes too warm, or the wrapping-sheet too dry, 
it should be wet with cool or tepid water, 65° to 75°, without being re- 
moved, so that the patient may continue at perfect rest. There can 
be no danger in continuing this treatment for days, provided the tem- 
perature of the patient is carefully kept near the natural standard. 
When caused by a wound, the injured part should be covered with sev- 
eral folds of cold wet cloths — as cold as can be borne, without incretis- 
ing the pain, which should be frequently changed. If able to swallow, 
the patient should drink rather freely, and as much cold water should 
be occasionally thrown into the bowels by a pump-syringe as they can 
conveniently receive 



SPASMODIC DISEASES. 231 

Locked-Jaw — Trismus. — This disease differs from the former in 
the spastic rigidi ty of the muscles being chiefly confined to the lower 
jaw ; from which circumstance many authors regard it as a mere form or 
variety of tetanus. It has also been designated as traumatic, when 
arising from wounds, surgical operations, or other local injuries; and 
catarrhal, when produced by colds. Sometimes it attacks infants soon 
after birth, constituting tho trismus nascentium of Dr. Good. 

Symptoms. — Sometimes the attack is sudden, but usually the symp- 
toms come on gradually; there is more or less of an uneasy sensation 
at the root of the tongue, and some degree of difficulty of swallowing. 
The spasms sometimes extend to the muscles of the chest or back ; the 
breathing is nasal; articulation is interrupted and slow; the muscles of 
the nose, lips, mouth, and of the whole face are fixed and distorted, and 
the jaw bone is often so firmly set as to break before the muscles will 
yield to mechanical force. 

Special Causes. — Mechanical injuries, especially the wounding of 
nerves in bleeding and surgical operations ; gun-shot wounds, punc- 
tured wounds by nails, splinters, pieces of glass ; extreme vicissitudes 
of temperature, etc. Obstructed bowels is a frequent cause of the in- 
fantile variety. 

Treatment. — The general plan of medication is similar to that of the 
former variety. Derivative baths may be here employed, in addition, 
with advantage, of which the tepid shallow-bath, accompanied with 
active hand-rubbing, is the best. The bowels should be freely moved 
by warm water injections. 

Cramp. — This affection is often symptomatic, as in various species 
of colic, cholera, and other diseases. Pregnant women, whose habit 1 * 
are too sedentary, or whose diet is too concentrated, are often troubles 
with fugitive cramps about the hips or in the muscles of the lower ex- 
tremities. 

Symptoms. — The disease consists of a sudden contraction and convo- 
lution of one or more muscles, attended with extreme but temporary 
pain. The stomach, neck, calves of the legs, and toes, are the parts 
most frequently attacked. When the hollow viscera or membranous 
muscles are affected, the pain is agonizing, a violent perspiration usu- 
ally breaks out, and the part feels as though it were puckered and, 
drawn to a point. When the stomach is attacked, the breathing is 
short and distressing. 

Special Causes. — Sudden exposure to cold or damp when the body 
is relaxed ; flatulence of the stomach or bowels ; long-continued pres- 
sure ; overstretching the muscles Acr'. bile is a frequent cause of 



232 PATHOLOGY AND THERAPEUTICS. 

cramp in the stomach, and acrid drugs are a common canse of acrid 
bile ; hence we meet with the most obstinate cases among obstinate 
drug-takers. 

Treatment. — The paroxysm can be relieved in a variety of ways. 
The warm douche, followed by the cold dash ; hot fomentations ; the 
warm hip-bath and foot-bath are applicable to cramp in the stomach ; 
when seated in the external muscles or extremities, the hot or cold 
douche will each relieve it ; it can also be speedily overcome by forci- 
bly pressing the affected muscle against a hard, resisting body, as, for 
example, the ball of the toe, or the heel against the floor, foot-board, 
or upon the other foot. The cramping diathesis may be entirely erad- 
icated by daily bathing, plain, unconcentrated food, and regular and 
active exercise. 

Muscular Distortion or the Spine— Spinal Incurvation. — 
" Spinal disease," " spinal weakness," " spinal irritation," etc., are 
among the rapidly-increasing diseases which tell of our enervating 
habits and consequent physiological degeneracy Spinal distortions may 
result from organic affections— caries 01 injuries — of the vertebral col- 
umn, or from osseous malformation, as in rickets and scrofula; but the 
great majority owe their existence to simple muscular debility. 

There is no part of the great field of " medical science" in which a 
more blundering pathology, a more unfortunate diagnosis, and a more 
empirical practice prevail than that relating to spinal complaints. All 
through the country weakly females abound, whose backs have been 
blistered, burned, scarred, cauterized, leeched, cupped, scarified, pus- 
tulated, and otherwise tortured, with the view of counter-irritating a' 
spinal disease, when in fact they have had no spinal disease at all ! Any 
form of indigestion, any morbid condition of the liver, kidneys, and any 
form of mismenstruafion, may produce a sympathetic irritation of some 
portion of the spinal column; and in many of these diseases of the ab- 
dominal and pelvic viscera, a tenderness will be. found by pressing 
firmly on that part of the spine from which the nerves are sent off to tlie 
organ or part really diseased. This symptomatic tenderness the doc- 
tor mistakes for an idiopathic disease, and plies his destructives accord- 
ingly. Again, when the whole body is debilitated by fine food, hot 
drinks, close rooms, sedentary habits, etc., the whole muscular system 
is necessarily relaxed ; it has not sufficient firmness and elasticity to 
sustain the trunk of the body erect, and perform its varied motions with 
ease and energy ; hence, like the masts of a ship, when the ropes are 
weakened or destroyed, the vertebnil column bends, leans, or tips back- 
ward, forward, or to ^ne side — usually the latter; and again the med- 



SPASMODIC DISEASES. 23?, 

ical man, again misapprehending the state of affairs, instead of attend- 
ing to the health in general, and strengthening the weak muscles in 
particular, administers his internal drugs and drastics, and puts on his 
external liniments and plasters, or endeavors to give support to the fall- 
ing frame by binding it up with a set cf awkward and complicated ma- 
chinery. Thousands of females have had real diseases inflicted upon 
them by the physician's attempts to cure the imaginary one. 

-The "small of the back" is the center of the whole muscular sys- 
tem ; it is the strong or weak point with every person, and no less than 
three hundred distinct muscles are concerned in the complicated move- 
ments of the vertebral column ; hence it is no* lifficult to understand 
how a relaxed or weakly condition of the general system should be es- 
pecially manifested in a muscular distortion of the spine. 
.• Special Causes. — Under this head I am most happy to quote the fol- 
lowing sensible observations from a standard allopathic book, more espe- 
cially as I have so frequent occasion to dissent from the sense expressed 
in the works of that school. 

"In rustic life we have health and vigc, and a pretty free use of 
the limbs and the muscles, because all are left to the impulse of the 
moment to be exercised without restraint. The country girl rests 
when she is tired, and in whatever position she chooses or finds easi- 
est, and walks, hops, or runs, as her fancy may direct, when she has 
recovered herself; she bends her body and erects it as she lists, and 
the flexor and extensor muscles are called into equal and harmonious 
play. But instead of this, let the child of the opulent be compelled to 
sit bolt upright in a high, narrow chair with a straight back, that hardly 
allows of any flexion to the sitting muscles, or of any recurvation to the 
spine ; and let the whole of her exercise be, instead of irregular play 
and frolic gayety, be limited to the staid and measured march of Mel- 
ancholy in the Penseroso of Milton : 

" ' With even step and musing gait ;' 

to be regularly performed for an hour or two every day, and to consti- 
tute the whole of her corporeal relaxation from month to month, gird- 
ed moreover, all the while, with the paraphernalia of braces, bodices, 
stays, and a spiked collar, and there can be no doubt that the young 
heiress will exhibit a shape as fine and a demeanor as elegant as fashion 
can communicate, but at the heavy expense of a languor and relaxa- • 
tion of fiber that no stays or props can compensate, and no improve- 
ment in figure can atone for." 

Diagnosis. — In organic or structural derangements, the distortion is 
from within outward, forming a sharp projection of the bones, called 



234 PATHOLOGY AND THERAPEUTICS 

angular curvature, in contradistinction to the disease before us, which 
is usually termed the lateral curvature ; and this may be right or left, 
as the muscles on the right or left side of the body are more debilita- 
ted from peculiar personal habits, ordinary bodily positions, etc The 
muscles of- the back are more or less emaciated ; the soreness or ten- 
derness upon pressure is a very variable sj'mptom ; it may be constant 
or occasional, severe or slight, or entirely absent. Paralysis of the low- 
er extremities is a common symptom of the organic or true spinal dis- 
ease, especially when the displaced vertebra? press severely on the spi- 
nal cord, and when any portion of the cord or medulla oblongata is af- 
fected with a softening ^amollissement — or other abnormal transforma- 
tion. Some authors have imputed the lateral or muscular curvature to 
an over-action of some of the muscles of one side ; but the exact con- 
trary — want of action — is invariably the fact. Some authors regard the 
muscular distortion as the predisposing cause of the bony distortion ; 
while others regard the disease of the bones and a relaxation of their 
ligaments as the producing cause of the muscular depressions. Nei- 
ther hypothesis is correct; for both affections, as already intimated, 
commence, progress, and terminate independently of each other : one 
being strictly organic, and primarily affecting the bones ; the other 
purely functional, and primarily seated in the muscles. Sometimes the 
rniscurvation is double, forming a sigmoid flexure ; and the contortion 
is said to be more frequently on the right side than on the left, prob- 
ably owing to the more frequent extension of the right hand, the body 
being thrown toward the left to preserve the central point of gravita- 
tion. 

Treatment- — First of all in importance is the general regimen. All 
superfluous clothing must be thrown oft"; silks and flannels next the 
6kin must be eschewed ; all artificial support must be withdrawn, and 
every thing about the body or dress which interrupts in the least free 
and varied motion is to be removed. Exercise in the open air should 
be frequently tak^n, and such gymnastics as call ''he muscles more es- 
pecially debilib ced into action, should be indulged with moderation, and 
regularly persisted in. The bed should be easy but not heating. A 
good hair mattrass answers very well, and a bed well filled with new 
oat straw is still better ; the patient, during sleep, should recline as 
nearly on the horizontal posture as is consistent with quiet rest, but not 
put on an uncomfortable stretch, as some authors have advised. The 
dietetic plan should consist, to a large extent, of plain, unmixed, solid 
and dry articles and preparations, as brown bread, with baked apples ; 
wheaten grits and sugar, with' uncooked apples; wheat meal or Indian 
cakes, with vn''lk ; roasted potatoes and milk, with dry crusts of "ood 



SPASMODIC DISEASES. 235 



sweet bread ; Graham crackers, with ordinary vegetaties and fruits, 
etc. Cold water should be drank in the forepart of the day, especially 
soon after rising, as freely as the stomach will bear without decided 
discomfort; and if the bowels are in any degree torpid, a daily injec- 
tion should be employed. 

The bathing part of the treatment should be as strictly tonic as pos- 
sible. The dripping-sheet, followed by active and prolonged rubbmg 
with the dry hand ; or the tepid shallow-bath, followed by the pail 
douche, and this, succeeded by hand friction, should be employed daily 
when practicable, and the towel-wash substituted when both are im 
practicable. The douche to the whole surface of the back may be em 
ployed once or twice daily. The stream should be of moderate force, 
and applied from two to five minutes. The hip-bath will also be highly 
serviceable, by constringing the relaxed muscles at, the very point of 
their greatest relaxation. The air-bath is also worth recommending in 
this place, and its advantage would be greatly enhanced by manipula- 
ting or shampooing the whole back, and especially in the immediate 
vicinit- of the morbid curvature. 

I may add, in conclusion, that Dr. Jarrold, who once wrote an elab- 
orate treatise on this complaint, limited his medication almost exclu- 
sively to burned sponge and the carbonate of soda, from which treat- 
ment he is said to have experienced remarkable success ; but it is 
worthy of note that his hygienic auxiliaries were, a recumbent posture, 
shampooing, friction, pure air, occasional exercise, and careful atten- 
tion to diet. I am of opinion his hygiene effected the cure, while the 
drugs were useless or nearly insignificant. 

Muscular Stiff Joint. — This affection, which consists of a per- 
manent and rigid contraction of one or more articular muscles or their 
tendons, may arise from spasmodic contraction or from simple atony : 
the former kind often results from rheumatism, and the latter from 
long confinement or neglect of use; colds, strains, and inflammations 
occasioniilly produce it. The douche, compresses, active and prolonged 
friction with soft flannel or silk, or, better still, the bare warm hand, 
are the " meihodus medendi," 

Wry Neck. — A permanent contraction of the flexor muscles of one 
side of the neck, or a loss of the balance of action between the flexors 
and extensors, by which the head is drawn obliquely to the right or 
left, may be occasioned by a natural disparity in the length of the op- 
posite muscles, and only curable, if at all, by a surgical operation ; or 
by a spasmodic fixation of one or more muscles on the contracted side; 



236 PATHOLOGY AND THERAPEUTICS. 

or from debility of the muscles on the opposite or yielding side ; or 
from the two last conditions combined. The first variety is generally 
congenital, but sometimes results from burns and other injuries ; colds 
and strains are the usual causes of the last three varieties, the curative 
method for which is the same as for the preceding disease. 

Hiccough — Hiccup — Singultus. — The disease before us, and all 
others arranged under the head of ch-onic spasm, are frequently symp- 
tomatic affections. In rare instances, however, they seem to occur 
idiopathically ; that is to say, without any other apparent and well-de- 
fined primary malady to which they can be imputed. 

Symptoms. — Hiccough is defined, a convulsive catch of the respi- 
ratory muscles, with sonorous inspiration, iterated at short intervals. 
The spasmodic action, as in the case of vom'ting, is principally made by 
the diaphragm and external abdominal muscles. 

Special Causes. — Bile in the stomach, acidity, flatulence, indigesti- 
ble food, an overloaded stomach, external pressure, narcotics, intoxi- 
cating drinks. 

Treatment. — A draught of cold water, the foot-bath, cold compresses 
to the stomach. When occasioned by acrid bile, over-fullness of the 
stomach, or alcoholic liquors, warm water-drinking, thp cold abdom- 
inal bandage, and the cold injection. 

When the spasmodic action appears to be merely irritative, it can 
be checked at once by holding the breath as long as possible, and 
fixing the mind intently on some object ; violent sneezing, sudden 
fright, or almost any sudden and strong emotion of mind, will general- 
ly arrest it. Baron Dupuytren once cured an obstinate case by apply- 
ing a hot iron to the region of the diaphragm ; but whether the actual 
cautery or the actual fright actually cured the patient, medical gentle- 
men may differ; my opinion is in favor of the fright. 

Sneezing — Clonus Sternutatio. — Sneezing is a convulsive mo- 
tion of the respiratory muscles, by which air is driven violently and 
suddenly through the nostrils, producing a sonorous expiration. In the 
natural order of things the act is intended to eject from the mucous 
membrane of the nostrils any irritant or offensive material which ef- 
fects a lodgment there. Snufff-takers frequently so obstruct and para- 
lyze the nervous sensibility, that it is impossible to excite sneezing by 
all the pulvurulent narcotic the nose is pble to receive; while the un- 
depraved instinct will raise a violent commotion against the smallest 
particle of obnoxious dust or mephitic vapor. 

Special Causes. — Pungent dust, vapors, gases, or other local irri- 



SPASMODIC DISEASES. 237 

tants ; indurated mucous and acrimonious secretions, as in catarrh and 
measles; morbid sensibility of the Schneideriau membrane from acrid 
bile, and morbid secretions of the alimentary canal. 

Treatment. — Sniffing cool or cold water frequently, taking care to 
draw the fluid into the nostril by means of a moderate but prolonged 
inspiration, rather than by a forcible, jerking motion; in severe casesi 
derivative baths — the hip and foot — are useful; and in some cases of 
dyspeptic sneezing, the whole face requires " packing." I once had 
an inveterate dyspeptic under treatment, who was afflicted with an 
eruptive, erythmatic, or " cankerous" condition of the mouth, throat, 
stomach, and bowels ; and this occasioned such an excessively irritable 
state of the mucous membrane of the nose that the most trivial ex- 
citing causes would excite violent and painful attacks of sneezing ; these 
would continue, unless attended to, for hours, and until the whole face 
was greatly swollen, the eyes injected and tearful, and the sense of 
tickling and irritation incessantly annoying and intolerably distressing. 
The sneezing fit was several times stopped by placing several folds of 
wet cloths over the whole face, leaving a small aperture for breathing 
purposes, and covering these with dry flannel, so as to produce what 
has been called the "poultice" effect of the wet compress. 

Palpitation. — A subsultory vibrative motion may be limited to the 
heart alone, or the trunks of some of the larger arteries alone, or affect 
their ramifications in the viscera, constituting palpitation of the heart, 
of the arteries, and complicated or visceral palpitation. 

Symptoms. — Palpitation of the heart is a vibratory aDd irregular ac- 
tion, sometimes sharp and strong, and then called throbbing of the heart, 
and sometimes soft and feeble, when it is termed fluttering of the heart. 
In some instances the force of the heart's contraction has been so great 
as to shake the bed, be heard across the room, rupture the ventricles, 
and even fracture the ribs. In very nervous or irritable persons the 
palpitation often shoots from one artery to another, and sometimes a 
preternatural pulsation pervades every part of the body, the morbid 
sensibility being so acute that the patient not only feels the universal 
throbbing, but actually hears it. The temporal and carotid arteries are 
particularly subject to a migratory throbbing, which may be synchro- 
nous, or alternating with the beating of the heart. In dyspeptics, the 
descending aorta is often the seat of a most disagreeable throbbing, not 
nnfrequently mistaken for aneurism. 

Special Causes. — Palpitation is always symptomatic of some organic 
or functional difficulty, commonly the latter. All visceral obstructions, 
and every form of indigestion, are liable to be attended with this symp- 



238 PATHOLOGY AND THERAPEUTICS. 

torn. The use of tobacco, strong coffee, green tea, or ardent spirits 
very frequently produces the worst and most obstinate attacks. Strong 
mental emotions, if frequently repeated, or continuous mental excite- 
ments of any kind, tend to create a habitual, disorderly action of the 
heart and arteries. Probably constipation of the bowels is the cause 
of the most violent attacks on record. The most common structural 
derangements of which palpitation is symptomatic, are enlargement or 
induration of the heart ; aneurismal dilatation of its cavities ; ossification 
of its valves, or its connection with the aorta ; morbid accumulation of 
fat around the pericardium ; dropsical collections within the pericardi- 
um; adhesions of the pericardium. 

Diagnosis. — It is often extremely difficult to distinguish between 
functional and structural causes of palpitation. The following will serve 
as a general though not a universal rule : functional palpitations are in- 
termittent, while those produced by organic affections are continuous ; 
and to this T may add, that in all abnormal pulsations from functional 
derangement or nervous irritability, the character of the pulse is ex 
ceeding variable ; while in organic affections its abnormal character 
whatever that character may be, is nearly uniform. It may afford 
some consolation for invalids with this affliction to know that not more 
than one in ten of those who are suspected, by themselves or by their 
physicians, of an organic cause, ever find more than a functional de- 
rangement. 

Treatment*-- As the disease is merely secondary, all we have to do 
is to trace it to the primary malady, and treat that according to its 
character. 

Nictitation. — A rapid and vibratory motion, or tivinkling of the 
eyelids is named as a distinct disease by some authors. When the 
eye has been frequently exposed to dust, or pungent gases, vapors, etc., 
a morbid sensibility sometimes remains after the cause of irritation has 
been removed, producing an irregular, convulsive, and unsightly wink- 
ing. It has been overcome by a powerful exertion of the will, and by 
employing only one eye at a time. Frequent cold bathing, followed 
by gentle manipulation, seems well adapted to restore the natural tone. 

Subsultus. — Sudden and irregular twitches or snatchinga of the 
tendinous extremities, are generally indicative of extreme debility, and 
are hence common in low fevers, and the latter stages of many futal 
disorders. But sometimes a feeble convmsive action is load and hab- 
itual. Nervous and irritable persons, of otherwise fair health some- 
times are troubled with a jerking, spasmodic action of the muscles of 



DISEASED OF GENERAL TORPITUDE. 289 

the shoulders, hands, feet, etc. Such cases almost always depend on 
some obstruction of the skin, or bowels, or both, and are curable by 
a daily bath, coarse opening food, and cool injections. 

Stretching — Pandiculation. — It requires some stretch of imag- 
ination to regard what Dr. Good defines "transient elongation of the 
extensor muscles, usually with deep inspiration and a sense of lassi- 
tude," as a distinct disease. Yawning, gaping, and stretching are in- 
stinctive efforts to recover the balance between the flexor and exton- 
sor muscles ; and are sometimes excited by misposition, and at others 
by certain morbid conditions, as nausea, the shivering stage of fever 
and ague. Most frequently, however, that kind of stretching which au- 
thors have dignified with the title of a malady, under the name of pan- 
diculation, is symptomatic of indolence ; hence it is rather peculiar to 
loungers, who " cannot rise from the sofa without stretching their limbs, 
nor open their mouths to answer a plain question without gaping in 
one's face." The remedy is occupation. 



CHAPTER XI. 

DISEASES OF GENERAL TORPITUDE 

The diseases constituting the present chapter, are distinguished by 
general muscular immobility, with mental or bodily stupor. They 
form a striking contrast with those of the preceding chapter, and em- 
brace the following species : 

Asphyxia — Suspended Animation. 

Ecstasy— Spurious Catalepsy. r Hemiplegia, 

Catalepsy — Trance. Palsy J Paraplegia, 

Lethargy — Deep Sleep. ( Particular. 

Apoplexy. 

Asphyxia — Suspended Animatioh - -Apiwrent Death. — The 
term asphyxia, or asphyxy, is often used in the limited sense of acro- 
tism or pulselessness, and is generally restricted to that suspension of 
xll the powers of sensation anc voluntary motion which is immediately 
owing to non-arterialization of the blood from interrupted respiration. 



240 PATHOLOGY AND THERAPEUTICS. 

But in a more comprehensive sense it has been, and in the present 
sense is employed to denote all cases in which a total or partial suspen- 
sion of the mental and corporeal functions characterizes the access of 
the disease. 

Symptoms. — These vary with the producing cause. In asphyxia 
from suffocation, as in hanging or drowning, the countenance is turgid, 
and suffused with livid blood ; the eyeballs are protruded, 

" otaring full ghastly, like a strangled man ; 
Hie hair upreared, his nostrils stretched with struggling." 

When the asphyxia is produced by inhaling carbonic acid — choke- 
damp — or other irrespirable gas or mephitic exhalatiou, the countenance 
is pallid, the whole surface is also pale, and death often takes place in- 
stantly, save when the deleterious aura is largely diluted with common 
air, in'which case the symptoms more or less resemble apoplexy. Of the 
gases positively pernicious to breathe, are the carbonic acid, often found 
in close rooms where charcoal has been burned, in the bottom of wells, 
or large beer-casks, and in natural caverns; the carburetted hydrogen, 
and various compound gaseous products evolved from decomposing an- 
imal and vegetable substances, and from the putrefying corpses of cem- 
etaries; and of the negatively injurious gases — those which do not sup- 
port respiration — are hydrogen and nitrogen ; some of their com- 
pounds, however, with sulphur, carbon, and phosphorus, are abso- 
lutely destructive. The fumes of mercury, lead, and various other 
metallic substances, when highly concentrated, operate with as sudden 
fatality as the fu mes of charcoal. 

In electrical asphyxia, which is produced by a stroke of electricity or 
lightning, the limbs are generally flexible, the countenance is pale, and 
the blood is incoagulable ; usually the limbs do not stiffen after death, 
and the body becomes rapidly putrescent. Sometimes no external in- 
jury whatever is observable ; but in other cases the skin is vesicated, 
the hair is scorched, and the body more or less lacerated and torn. 

When the disease results from intense sold— frost-bitten asphyxia— 
the limbs are rigid, the countenance pale and shrivelled ; it comes on 
more gradually than the other forms; there is a tende-ncy to sleep, 
which increases as the period of exposure is extended; and when this' 
is joined with fatigue, the torpor and drowsiness often become irre- 
sistible. 

Various narcotic poisons, as cicuta, tobacco, and Prussic acid, when 
taken in large quantities, and also the anesthetic agents, as ether and 
chloroform, in extreme doses, will produce asphyxia, attended with 
total insensibility and universal muscular relaxation. 



DISEASES OF GENERAL TORPITUDE. 241 

Treatment. — This must vary with the cause. The variety produced 
by hanging is hardly a medicable case ; yet if the strangulation has not 
continued too long, nor the neck-joint been fractured or dislocated, 
there is a chance of restoring respiration by so;r.e of the means about 
to be mentioned. Death from submersion does not result, as is gen- 
erally supposed, by water entering and filling the lungs, but from suf- 
focation produced by a spasmodic constriction of the glottis — an instinct- 
ive effort to keep the surrounding water out of the lungs. How long 
life can be maintained under water is uncertain ; and the time probably 
depends partly on the natural capacity of the lungs, and partly on the 
extent to which they happen to be inflated when respiration ceases. 
Individuals can generally be resuscitated if not submerged more than five 
minutes ; very often after having been ten or fifteen minutes under 
water ; and in some instances persons have recovered after an hour's 
submersion. Recoveries have been reported after a much longer sub- 
mersion — several hours, and even several days ; but such reports seem 
to challenge human credulity rather severely. Be this as it may, our 
duty is plain ; it is to endeavor to resuscitate the patient so long as 
there are the least indications of a spark of remaining vitality. Instan- 
ces are well authenticated of patients having recovered after a perse- 
verance in the restorative means for eight or ten hours. 

The remedial plan comprises two distinct indications : 1. To restore 
warmth and circulation to the surface. 2. To inflate the lungs. In 
the first place, the patient should be wiped dry, wrapped in clean warm 
blankets, and conveyed in a recumbent posture on the back, with the 
head and breast raised, to a warm, dry, well-ventilated room, and sur- 
rounded by no persons except the necessary attendants. Dry warm 
flannels, and bottles or bladders of warm water, or bags of warm grain 
or sand, are to be applied to the stomach, feet, and sides, and the sur- 
face should be thoroughly and perseveringly rubbed by the warm dry 
hands of the attendants. The mouth and nose should be promptly 
cleansed of the obstructing mucus, and the foul air may be sucked 
out by means of a tube, which may also be used for inflating the lungs, 
as in figure 187. 

The inflation of the lungs is the most important, of all the curative 
processes. This may be done by repeatedly forcing into the patient's 
mouth — the nostrils, meanwhile, being held close — a full expiration 
of air from the lips of an attendant, or by means of the tube repre- 
sented in figure 187, alternating the expiration with moderate but 
firm pressure on the external abdominal muscles, so as to simulate 
all the motions of natural respiration. A common bellows, when well 
managed, is preferable, because it will convey pure, unrespired air to 

ri-2i 



242 



PATHOLOGY AND THERAPEUTICS. 



the lungs ; and if the bellows can be attached to a tube, and this in- 
troduced into the larynx, the effect will be better still. 
Fig. 187. 




•'fa 



INFLATING THE LUNGS. 



It may excite the surprise of the non-professional reader to be told 
tliat bleeding, even in the asphyxiated state, is an approved allopathic 
remedy in this disease. Many physicians of " high authority" recom- 
mend opening the jugular; while other high authorities oppose the 
practice, not on the ground of its impropriety, but because the blood 
will seldom flow if the jugular is opened. Samuel Cooper dissents in 
part. He says : " Bleeding ought never to be employed in this stage 
of the process, though it may become necessary when the circulation 
has returned, and reaction has taken place." This means, liberally 
interpreted, that after the patient is out of danger it will not kill him to 
lose a little blood, although it might have been the death of him while 
the danger existed! 

When the disease is caused by deleterious gases, narcotic or metal- 
lic fumes, etc., or the anaesthetic agents, the treatment chiefly consists 
in exposing the patient freely to the open air, dashing cc-!d water in the 
face, pouring cold watei over the head, and active friction with pulmona- 
ry inflation, as in the preced.ng variety. Injections of cold water are 
also serviceable ; sprinkling or dashing cold water over the surface, fol- 
lowing the application with active friction with the bare hand, has beer 
tried with evident advantage. 

In the case of apparent death from electricity, all the appliances jusl 
named may be called in requisition.; but as far as experience can guide 
us, dashing cold water freely over the breast, face, and even the whole 
body, and the prolonged pouring-bath to the head, are the ;nost im- 
portant processes 



DISEASES OF GENERAL TOKPITUDE. 243 

Here again, many of the shining lights of allopathy insist that, the pa- 
tient ought to lose a little of his blood, as well as all of his sensibility. 
M. Portal recommends opening the external jugular ; Dr. Doane thinks 
the abstraction of a few ounces has done good; and Dr. A. H. Ste- 
vens, of this city, has recorded a case of injury by lightniag successful- 
ly treated by copious venesection ; that is to say, the amount of blood 
drawn within ten days was about one hundred and twenty ounces! If 
a patient can survive a stroke of lightning long enough to go through a 
ten days course of venesection, it is conclusive evidence that he can 
live better without the remedy than with it. Dr. Stevens has afforded 
another demonstration of the old proverb, that many patients recover in 
spite of the disease and the doctor. 

In asphyxia from cold, the application of warmth must be cautiously 
managed. When a limb or part is frozen, the coldest water should be 
employed in the first instance, and the temperature gradually raised ; 
the patient, meanwhile, should be kept in a moderately cool atmosphere 
until the circulation is restored. E,ubbing the frost-bitten part with 
snow until sensibility returns, and then with warm water, and after- 
ward the dry hand, is an excellent plan. In cases of extreme torpor, 
from cold when no part is absolutely frozen, friction with wool, flannel, 
or the dry hand is appropriate. 

Ecstasy. — This affection is peculiar to those states of bodily de- 
rangement of which mental aberrations or extravagances are symptomat- 
ic ; hence it attacks chiefly melancholic, hypochondriac, visionary, aud 
abstracted persons. 

Symptoms. — The paroxysm consists of a sudden and total suspen-sion 
of sensibility and voluntary motion, the pulsation and breathing contin- 
uing, with rigid muscles, and an erect and inflexible position of body. 
In most cases there is also a complete suspension of mental power. 
The duration of the fit varies from two or three hours to us many days, 
at the end of which the patient rouses as from sleep. 

Special Causes. — A morbid state of the liver ; powerful mental 
excitement; long-continued meditation on a particular subject; pro- 
longed suspense of mind ; venereal excesses ; self-pollution or ona- 
nism. 

Treatment.' — Out-door exercise by walking, riding, sailing; varied 
scenery; lively company ; cheerful conversation ; amusements of the 
laughable kind ; regular employment or occupation, with a daily bath 
and plain food. 

Catalepsy. — The only essential distinction authors make between 



244 PATHOLOGY A3D THERAPEUTIDS. 

ecstasy and trance is that of the flexibility or inflexibility of the mus- 
cles ; in the disease under consideration the muscles are lax and yield- 
ing, and the body yields to and retains any given position. The eyes 
remain open, and are fixed intently upon some object, but usually no 
perception acc&mpauies the apparent vision. Tho fit generally comes 
on without premonition, and in most cases closes with singing. Its du- 
ration is from a few minutes to several days. This affection is some- 
times counterfeited, and the real disease has been sometimes mistaken 
for actual death. The causes and treatment are the same as those of 
the preceding disease. 

Lethargy. — Deep sleep does not perfectly express the leading char- 
acter of this disease, as it is sometimes wanting. Lethargy is distin- 
guished from asphyxia, ecstasy, and catalepsy, by the apparent general 
ease and quietude of the body ; and from apoplexy, by the eyelids be- 
ing closed and the limbs gently reclining, as in natural sleep. 

Symptoms. — Sometimes the sleep is profound, and without intervals 
of sensation, waking, or consciousness; sometimes the sleep is remis- 
sive, and the patient occasionally awakens and recovers sensation and 
speech, constituting the coma somnolentum of authors ; and in a third 
variety — the typhomania and coma vigil of pathologists — there is a 
perfect lethargy or insensibility of the body; while the mind is only 
imperfectly lethargic, manifesting confused and wandering ideas, and, 
during sleep, possessing a belief of wakefulness. This form is fre- 
quently a symptom in various fevers. 

Special Causes. — Violent menta ^ommotion, fright, furious anger, 
excessive mental labor, night-work, lepelled eruptions or exanthems, 
congestion or effusion in the brain. 

Treatment. — Essentially the same as in the preceding two diseases, 
save that the exercise must be of the recreative rather than laborious 
kind. The pouring head-bath is a promising measure during the 
paroxysm. 

Apoplexy. — This disease is one of the results of a constipated, ob- 
structed, plethoric, and overburdened body. Excessive alimentation, 
with defective depuration, and some internal visceral obstructions or 
compressions, are the obvious conditions on which the apoplectic fit de- 
pends ; and hence we rarely witness the disease except among the 
full-fed, the corpulent or obese, and the gross or high livers ; and eveD 
then we almost invariably find inattention to the functions of the ex- 
creting organs or outlets of the body among the predisposing circum- 
stances. 



DISEASES OP GENERAL TORPITUDE. 245 

This view is simple enough, and not difficult to understand. But in 
medical books we find a world of confusion on the whole subject. 
Every thing relating to its causes, seat, nature, and proper treatment, 
is there hypothetical, unsettled, contradictory — a mountain mass of sci- 
entific absurdity and erudite inconsistency. 

Some authors regard it as a disease of the sanguineous system ; 
others as an affection of the nervous system. Some writers contend 
that the immediate cause is always some effusion, extravasation, or 
other structural derangement in the brain; while others declare that 
such circumstances are never necessary conditions. Some pathologists 
argue that compression of the brain is the universal immediate cause; 
while others as ably theorise that the brain is incompressible. And in 
relation to treatment, some authors rely on copious bleedings and other 
depletory processes as the only hopeful treatment ; others condemn 
large bleedings as injurious, but go for small ones ; while others con- 
demn all bleeding and all depletion as bad, and advocate the very oppo- 
site treatment — brandy and general stimulants ; and yet others con- 
sider bleeding good in some cases and bad in others, the great point 
of skill in the physician being to determine when to employ and when 
to withhold the lancet. 

Symptoms. — The distinctions which authors make of this disease, 
into sanguineous and serous, entonic and atonic, simple and congestive, 
etc., are unimportant, as they relate only to the greater or less debility 
of the patient at the time of attack. Sometimes the disease comes on 
suddenly without the least premonition ; sometimes the attack is pre- 
ceded by a sudden paralysis of one side of the body, and sometimes it 
is ushered in by acute headache, nausea, faintness, noises in the ears, 
confused vision, incoherence of ideas, loss of memory, and numbness 
of the extremities. The fit is characterized by complete insensibility ; 
slow, noisy, and usually stertorous or puffing breathing ; impeded 
deglutition ; flushed and livid countenance ; prominent and motionless 
eye, and generally a fixed or contracted state of the pupil ; the limbs 
are rigid, motionless, or convulsed ; the bowels are obstinately consti- 
pated, or the feces pass involuntarily ; the urine is passed uncon- 
sciously, or retained until the bladder is full, then dribbling away. The 
pulse is variable ; it may be full, hard, and quick, or weak and 
frequent. 

Diag-iosis. — It may be distinguished from the stupor of drunkenness, 
by the alcoholic odor of the breath in intoxication, and from the narcosis 
produced by various poisons, by the capability of occasionally rousing 
the patient in the latter affection. 

T~eat?nent. — The first thing to be done is to remove the patient to a 



246 



PATHOLOGY AND THERAPEUTICS. 




POSITION IN APOPLEXY. 



cool, spacious, \ve!l- ventilated apartment, kosen all the clothing about 
the chest, remove e/e-y thing from around the neck, and place him in 
an easy and nearly upr ght posture, as in fig. 188. 

Fig. 138. Follow the preparatory 

measures with the cura- 
tive processes, which con- 
eist mainly of the pouring 
bead bath ; wa'-m water 
and warm cloths to the 
feet, and occasionally hot 
fomentations to the abdo- 
men. If the fit continue, 
the cold stream may be 
applied to the head for a 
quarter to half an hour, 
several times a day ; the 
cold wet girdle to the ab- 
domen should succeed the 
hot fomentation, which may be resorted to eveiy two or three hours, 
for ten or fifteen minutes each time ; and friction to the lower ex- 
tremities with a cold wet cloth, followed by the warm flannel or dry 
hand rubbing, is a valuable auxiliary. No attempt should be made to 
give any thing by the mouth, until the breathing is materially relieved, 
and then only moderate draughts of cold water should be administered. 
The prophylaxis, or preventive medication, consists in a daily cold 
bath, plain, simple, abstemious diet, regular hours for eating, laboring, 
and resting, and a careful avoidance of all violent exertion, strong men- 
tal excitements, depressing passions, etc. 

Palsy — Paralysis — Paresis. — The same general causes which 
tend to the production of apoplexy, are among the most efficient pre- 
disponents to palsy. The disease before us, however, is more fre 
quently dependent on organic changes; and when merely functional, 
is more generally connected with nervous exhaustion. The ancients 
regarded apoplexy and palsy as modifications of one essential disease ; 
" apoplexy being a universal palsy, and palsy a partial apoplexy." 

Symptoms. — Paralysis may be attended with a total or partial loss of 
sensation only in the part affected, or a loss of voluntary motion only, 
or of both. The procursive symptoms are sometimes the same as 
those of apoplexy, but more generally the disease comes on gradually, 
an occasional sense of weakness, and troublesome but transient feelings 
of nuwiDness being the leading admonil ons ; and these are often ob- 



DISEASES OF GENERAL TORPITUDE. 247 

servable in a single finger, in one eye, the tongue, or one side of the 
face alone. 

In the kemiplegic variety the disease is confined to one side of the 
body, which is affected from the top to the bottom of the mesial line. 
This form is often a sequel of apoplexy. 

In the paraplegic variety the lower part of the body is paralyzed on 
both sides, or any part below the head. When not caused by some 
local injury, it is almost always preceded by costiveness. 

Particular or local palsy is confined to particular limbs, or to a par- 
ticular part of the body. When it affects the face, the expression of 
countenance is peculiar, the features are drawn to one side, and of 
course the two sides are not symmetrical, and the deformity is in- 
creased when the patient attempts to whistle, speak, laugh, cry, sneeze, 
or cough. 

A variety of local paralysis, to which those who work in quicksilver 
mines, at water-gilding, etc., are subject, called mercurial tremor, comes 
on with weakness and convulsive twitchings in the arms, gradually ex- 
tending to the lower extremities, and finally to the whole body ; and 
another variety, called lead palsy, or dropped hand, which attacks gla- 
ziers, plumbers, oil-painters, enamel card-makers, etc., begins by a 
feeling of weakness in the fingers, and extends to the wrist, but rare- 
ly beyond it , shooting pains affect the arm and shoulder ; the parts 
affected waste and emaciate, and the hand hangs loosely and uselessly 
at the wrist. 

Special Causes. — Most of the causes of apoplexy : enlarged or 
indurated liver or spleen ; constipation ; venereal excesses ; metallic 
fumes; narcotics; alcohol; pungent stimulants; acrid medicines, as 
copavia, turpentine ; sudden and extreme alternations of temperature ; 
pressure upon the brain, spinal marrow, etc. ; fever tumors, injuries, 
extravasations, effusions ; loss of nervous communication from structu- 
ral degeneration ; intense mental emotion ; prolonged wakefulness, or 
excessive night-work. 

Treatment. — The prospect of cure must be predicated upon the 
prospect of the cause or causes being structural or functional, which 
point, however, is not always easy to determine. But in either case 
the plan of medication is obvious, and the same. Some few cases ar« 
attended with a difficulty of respiration, and the indications of compres- 
sion of the brain, resembling apoplexy, and require similar manage- 
ment. For bathing purposes, water should be employed as cold as can 
be borne without permanent discomfort ; though, as a general rule, the 
Oaths should be of short duration. In paralysis of one side, the ablution 
or dripping-sheet, may be the most convenient general bath ; the wet- 



248 PATHOLOGY AND THERAPEUTICS. 



sheet pack, followed by the plunge, is still better when there is a good 
degree of remaining vitality. When the lower part of the body or low- 
er extremities are palsied, the shallow-bath is evidently the best lead- 
ing water process, and it may be aided by frequent hip and foot-baths. 
In all cases thorough friction by means of flannels, flesh-brushes, hand- 
rubbing, shampooing, etc., should follow the application of water. A 
moderate douche applied generally to the spine, and locally to the part 
affected is serviceable in most cases. When the superficial heat is too 
low, or the general torpor too great to admit of the full-sheet pack, the 
half-sheet may be beneficially employed. Whenever the extremities, 
or any portions of either of them are paralyzed, the wet compresses, 
•well covered, should be constantly worn and frequently renewed. 
Careful attention must be paid to the diet; and to the state of the bow- 
els. Cool injections are generally necessary daily; the patient should 
drink moderately of cold water, and the general regimen should be 
precisely on the plan adapted to, and recommended for, the cure of 
dyspepsia. 



CHAPTER XII. 

VISCERAL TURGESCENCE. 

A swelling, fullness, or turgescence may exist in any part or organ 
in temporary obstructions, congestions, or inflammations ; but the pres- 
ent chapter is limited to those affections of the internal viscera in which 
the enlargement is chronic or permanent. It includes the following 
varieties, which make the species of Dr. Good's genus parabysma : 

Hepatic— Enlargement of the Liver ; 

Splenic, » « Spleen; 

Pancreatic, " " Pancreas ; 

Mesenteric, " « Mesentery; 

Intestinal, " " Intestines; 

Omental, " » Omentum; 

Complicated, " " Various Organs. 

Enlargement op the Liver— The structure and functions of the 
live,-, as described in the physiological part of this work, explain the 
reasons why the liver is more snbject to chronic enlargement £2 an $ 



VISCERAL TURGESCENCE. 249 

other organ in the body. The morbid alterations of structure which 
constitute its intumescence are various, as simple swelling, tubercular 
formations ; hydatid growths ; hardening, or induration ; softening, or 
fatty degeneration ; and that result of bad living and putrescent blood 
which pathologists have called black ramollissemenl, in which the or- 
gan is reduced to a dark-colored mass of very little consistence, etc. — 
conditions which are difficult of diagnosis during life. Another form of 
structural derangement has been called gin-liver, in which the biliary 
portion of the liver is both hypertrophied and indurated, as well as 
dropsical, from the effect of the free use of ardent spirits. 

Symptoms. — With general derangement of health, and various symp- 
toms of indigestion, particularly pale, yellow countenance, irregular and 
often whitish injections, a hard tumor may be found in the right hypo- 
chondrium, verging toward and often appearing at the pit of the stom- 
ach. In dropsical persons the swelling is sometimes enormous. An 
enlarged or indurated liver is common to persons who have suffered 
frequent or prolonged attacks of ague and fever, and has then been de- 
nominated ague cake. 

Special Causes. — All the common causes of vitiated blood and impure 
secretions tend to disease the liver ; but an obstructed skin, by which 
the decomposing and putrescent particles of the body are retained in 
the system, is the most efficient among them. Among the causes 
which operate indirectly in producing obstruction and enlargement of 
the liver, are concentrated food, animal oils, or greasy matters, swine- 
flesh, shell-fish, stale meats, old cheese, etc.; and among those which 
operate more directly to produce functional disturbance, followed by 
organic changes, are alcohol, tobacco, hot drinks, violent passions, etc. 

Treatment. — The indications are, 1. To promote as vigorous absorp 
tion throughout the entire lymphatic system as possible. 2. To purify 
and invigorate the general system. For fulfilling the first indication, 
the "hunger-cure," moderately but perseveringly employed, and a 
moderate douche, frequently applied over the back, especially on its 
upper portion and over the shoulder-blades, are the leading measures ; 
and for the second, the wet-sheet pack, or shallow-bath, or both, where 
the external temperature is considerable, are the best among various 
useful processes. The abdominal compress should not be neglected ; 
and when there is pain or tenderness about the epigastric region, or in 
its vicinity, or when the bowels are habitually constipated, the warm 
stream douche to the whole abdomen, followed by the cold dash, will 
be advantageous. 

I may just observe, en passant, that there is some slight discrepancy 
in the opini -ns of standard medical authors regarding the treatment of 



250 PATHOLOGY AND THEE APEUTIC S. 



the malady under consideration. Thus, Dr. Elliotson recommends 
iodine" and mercury as the principal remedies; but Abercrombie says 
that the mercurial practice uniformly sinks the patient in a very rapid 
manner. 

Enlargement cr the Spleen.— Pathologists seem to be generally 
of the opinion that structural disorders of the spleen occasion but very 
little mischief to the organic economy. I think differently. It is true 
that the consequences are much less apparent; but if the opinion I 
have heretofore advocated respecting the functional office of the spleen 
is correct, a derangement of its function must be followed by a loss of 
power, to some extent, throughout the entire range of the organic or 
nutritive functions ; although such resul* would not be manifested by 
any special local symptoms, as in the case of a similar morbid condition 
of the liver. 

Baron Dupuytren found that dogs maintained apparent good health 
after having their spleens extirpated ; but medical authors generally 
confess that " the more the spleen exceeds its natural size in the hu- 
man subject, and the longer it retains this abnormal condition, the more 
are the functions of respiration, digestion, etc., disturbed, and the great- 
er is the impairment of the general health." The key to an explana- 
tion of all these facts is within reach. The spleen is an appendage to 
the higher class, or brain-endowed class, of animals ; and its especial of- 
fice is to provide in part for the additional supply of organic nervous 
influence rendered necessary by the superstructure of the encephalic 
mass, while it performs a subordinate duty in supplying additional ner- 
vous influence to the general nutritive system. Hence the importance 
of the spleen in the animal kingdom has a direct relation to the size of 
the brain; which fact accounts for the lesser disturbance its disease or 
removal should produce in the small-brained than in the large-brained 
animal. 

Symptoms. — It is known by an indurated tumor in the left hypo- 
chondrium, verging toward the spine ; as with the preceding disease, 
there are symptoms of general ill health; but while in enlargements 
of the liver these symptoms assume the forms of jaundice and dyspep- 
sia, they will, in induration of the spleen, appear in the shape usually 
termed nervous debility. The patient seldom complains of pain in the 
region of the organ affected ; his appetite is good, but he loses flesh 
and muscular strength ; his features have a dark, bilious, or mahogany 
hue ; the skin is dry, the lips are pale, and the patient is not infrequent- 
ly morose and desponding. 

Special Causes,- -The disease often appears after obstinate intermit- 



VISCERAL TURGESCENCE. 251 

tent or remittent fevers ; scrofulous constitutions, and constitutions de- 
bilitated by intemperance are very liable to it; marshy situations and 
stagnant waters occasion it ; it has followed suppressed menstruation ; 
and medical authors name Peruvian bark, which is so immoderately 
administered in intermittent fevers, as a cause of enlarged spleen. This 
affection also called ague cake. 

Treatment. — The douche should be frequently applied, with as much 
force as the patient can comfortably bear, to the spine and left hypo- 
chondriac region ; and in all other respects the plan recommended for 
enlarged liver is to be pursued. 

Enlargement of the Pancreas — This is a rare disease, or at 
least, rarely detected in the living subject, but occasionally abscesses, 
scirrhus indurations, tubercles, calculous depositions, etc., have been 
found to occupy a part or the whole of its structure. 

Symjytoms.— These are obscure, except in extreme cases, when a 
hard, elongated tumor may be detected, extending transversely in the 
epigastric region, and accompanied with symptoms of dyspepsia and 
general debility. 

Special Causes. — From the analogy existing between the functions 
of the salivary glands and pancreas, fiuthors have judged the habitual 
excitement of the excretories of the former might be communicated 
sympathetically to the latter; and that hence tobac50-users were pe- 
culiarly liable to the complaint ; in confirmation of which, Dr. Darwin 
relates a fatal case which occurred in a great consumer of the article — 
" chewing it all the morning, and smoking it all the afternoon." 

Treatment. — As in the preceding varieties. 

Enlargement of the Mesentery. — Enlargement of this struc- 
ture mny"be in the form of hydatids, of tubercles, scirrhus induration ; 
fleshy, adipose, or fungus excrescences, or calculus deposits ; or sev- 
eral of these morbid alterations of structure may be coexistent. 

Symptoms. — The affection may be known by an indurated and irreg- 
ular mass of tumors below the stomach, yielding to the pressure of the 
hand ; the countenance is pale and bloated ; the appetite is irregular, 
often voracious ; and general atrophy or emaciation attends. 

The causes and treatment are similar to those of enlarged liver. 

Enlargement of the Intestines. — In some cases the induration 
is confined to the coats of the intestines ; and in others adhesions unite 
the intestines to the wals of the abdomen and to each other. 

Symptoms, — The int-~> ncscence may be round or elongated, hard or 



252 PATHOLOGY AND THERAPEUTICS. 

circumscribed ; but is movable by pressure made with both hands ; the 
action of the bowels is irregular ; there is usually obstinate vomiting, 
and more or less fever and emaciation. 

Treatment. — In addition to the general remedial plan applicable to 
all varieties of visceral turgescence, the peculiar symptoms of the af- 
fection before us demand frequent sips of iced water, cold compresses 
to the stomach, and the free employment of tepid injections. 

Enlargement of the Omentum. — Turgescence of the omental 
portion of the peritoneum, is usually of a complicated character — indu- 
rated, scirrhus, cartilaginous, and tuberculated ; in some instances the 
structure acquires almost a stony hardness. 

Symptoms. — The tumor is indurated and diffused, extending fre- 
quently over the entire abdomen ; it is accompanied with general ema- 
ciation and difficulty of breathing. 

The treatment does not differ essentially from that appertaining to 
enlarged liver. 

Complicated Visceral Enlargement. — This is merely a con- 
joint existence of several of the diseases we have already considered. 
It is denoted by a hard, elevated, and distended abdomen, resembling 
that of pregnancy ; the belly is, however, more or less knotty and un- 
equal ; the respiration is but slightly disturbed ; but there is usually 
acute pain, thirst, nausea, and vomiting. A diseased liver is the com- 
mon starting-point of these structural monstrosities ; and our only 
chance of cure is to employ assiduously, in the infancy of its malady, all 
the remedial appliances recommended under the head of enlargement 
of that organ. 



CHAPTER XIII. 

DROPSICAL DISEASES. 



The character of a dropsical affection may be defined : a pal9, indo- 
lent, and inelastic distention of some part or of the whole body, from 
accumulation of a watery fluid in the areolar tissue or other natural 
cavities. There is, however, one exception to this definition, in the 
case of internal hydrocephalus, which, though usually regarded as a 
dropsical disease, is, it reality, a strumous inflammation of the brain. 



DROPSICAL DISEASES. 253 

The principal forms of disease belonging to the chapter before us may- 
be grouped : 

Cellular ( General — Anasarca, Dropsy of ( External Hydrocephalus, 
Dropsy \ Local — (Edema. the Head ( Internal Hydrocephalus. 

Dropsy of the Spine — Spina Bifida. 
Dropsy of the Chest — Hydrothorax. 
Dropsy of the Abdomen — Ascites. 
Dropsy of the Ovary — Hydrops Ovarii. 
Dropsy of the Fallopian Tubes — Hydrops Tabalis. 
Dropsy of the Womb — Hydrops Uteri. 
Dropsy of the Scrotum — Hydrocele. 

( Cellular, 
Wind Dropsy — Emphysema } Abdominal, 

( Uterine. 

< Puerperal Tumid Leg, 
Inflammatory Dropsy J ^.^ Tumid Leg _ 

It is amusing to read the lengthened discussions which have been 
carried on by medical theorists respecting the proximate cause or es- 
sential nature of dropsy ; one party regarding it as a disease depending 
on diminished absorption, and the other as ably contending that the 
fault consists in increased exhalation. The practice predicated on the 
former theory is stimulation, and on the latter, antiphlogistication. But 
ns neither quinine nor bleeding effected a cure, a third party has lately 
entered the field of controversy, and cut the Gordian knot, by blending 
both doctrines in one ; and declaring that diminished absorption and in- 
creased exhalation produce the disease, the therapeutic indication be- 
ing to balance the action between the absorbents and exhalents. To this 
party we are indebted for the mercurial treatment of dropsy, which 
has proved even worse than its bad predecessors. 

Cellular Dropsy. — This affection is called anasarca when it ex- 
tends over the whole body, and oedema when limited to the areolar 
texture of the limbs. 

Symptoms. — Cold and diffusive swelling or puffiness of the skin, 
which pits beneath the pressure of the fingers ; the intumescence is 
greatest in depending situations ; and around the feet and ankles the 
accumulation increases toward evening, and decreases during the night. 
The skin is paler than natural, and when the distention is great it. as- 
sumes a shining appearance, which often becomes livid and discolored, 
and not unfrequently bursts in extreme cases. 



254 PATHOLOGY AND 1 HER APEUTICS. 

Special Causes. — All the causes of general debility predispose to 
dropsy. Intemperance, repelled eruptions, exhausting discharges, sup- 
pressed evacuations, and structural or functional obstructions of the kid- 
neys, skin, and liver, are among th< frequent causes. (Edematous 
swellings of the limbs are often symptomatic in mismenstruation, preg- 
nancy, etc., and frequently a result of mere debility, as in protracted 
fevers, etc. ; constitutions broken down by mer jury, are very liable to 
this disease. 

Treatment. — In all dropsical affections of the cellular membrane, the 
indications are, 1. To promote the absorption of the effused fluid. 2. 
To prevent its re-accumulation. The first indication is accomplished 
by promoting the activity of the excretory organs generally ; and the sec- 
ond by strengthening the whole system ; and either indication must be 
made the leading one, as obstruction or debility is the leading proxi- 
mate condition. As ageneral rule, quite cold water is preferable for bath- 
ing purposes, but the duration of baths should be short, and succeeded by 
active and prolonged, yet gentle friction with silk or soft flannel, or bet- 
ter still, the bare hand. The moderate douche, followed by a thorough 
rubbing in the dry blanket, and the wet-sheet pack, with warm bottles 
to the feet, and, if need be, the armpits, are among the best general 
baths. But as no two cases present the same set of circumstances, 
the practitioner will always find a wide field for the exercise of judg- 
ment. The diet must be mostly of the dry and unconcentrated kind, 
and water should be drank only to the extent demanded by actual thirst. 
Tepid injections should be freely employed when there is the least 
tendency to constipation. The warm douche, or spray-bath, followed 
by the cold dash or pail douche, is an excellent process when the 
swelling is tender and painful, and particularly serviceable if applied to 
the lower part of the abdomen when the kidneys are torpid or ob- 
structed, which will be known by scanty or difficult urination. 

A great deal of importance is attached, by most medical writers on 
dropsy, to the chemical ingredients in the urine, and the changes this 
secretion undergoes in hydropic patients ; and Dr. Johnson even ad- 
vises patients at a distance, when writing for advice, to send along a 
bottle of urine for the purpose of chemical analysis. Now people 
ought to know that, however amusing or interesting such experiments 
may be, they are of no utility whatever, as regards the cure of the 
disease ; for whether the urine is a little more or a little less albumin- 
ous, or ammoniacal, or alkaline, or acid, or saline, it is all the same as 
far as the treatment is concerned. 

J>Eopsr ok the Heat — Htdi jps Capitis. — External dropsy of 



DROPSICAL DISEASES. 255 

the head, commonly culled chronic hydrocephalus, consists of an accu- 
mulation of watery fluid in the ventricles or convolutions of the brain, 
or between the membranes, or between the bones and dura mater; 
and internal dropsy — acute hydrocephalus — is an inflammation of the 
membranes or substance of the lower part of the brain, which, in its pro- 
gress, runs into suppuration, and produces effusion into the ventricles. 

Symptoms. — In the first variety there is an oedematous intumescence 
of the head, while the sutures of the skull are usually separated ; the 
whole head appears preternaturally large, and the fontanelles are 
prominent ; in its a Vanced stages it is attended with languor, drowsi- 
ness, costiveness, vomiting, coma, frequently convulsions, and some- 
times strabismus. The second variety — the cephalitis profunda of Good's 
nosology — comes on gradually and insidiously; the precursive disturb- 
ances are languor, inactivity, loss of appetite, feverishness, etc. ; these 
are followed by darting pains in the head, great sensibility to light, 
contracted pupils, extreme restlessness, frequent sighing, disturbed 
sleep, from which the patient often starts with a scream ; in a later 
stage the bowels are irregular, the pulse small and frequent, and deli- 
rium and convulsions sometimes occur ; as the disease progresses the 
pupil dilates, the eyes usually present a squinting appearance, and a 
low moaning takes the place of the shrieks ; and near the fatal termina- 
tion, double vision or loss of sight, with lethargic stupoi, or violent 
convulsions occurs. Hydrocephalus is peculiar to infancy, and some- 
times commences in the foetus. 

Spiecial Causes. — Scrofulous, scorbutic, or syphilitic taint; repelled 
eruptions ; injury to the brain during labor ; bad dietetic habits of the 
mother during pregnancy; frequent exposure of the mother during 
pregnancy, or of the child soon after birth, to the powers of narcotic 
poisons, particularly tobacco. 

Treatment. — We can promise but, little in either form of hydro- 
cephalus unless detected and treated in the early stages. The general 
plan of management is the same as for the preceding disease, save 
that a good part of the treatment should be derivative — half, hip, and 
foot-baths, and the wet girdle to the abdomen. The pouring head- 
bath is advisable in the chronic or internal variety. The external form 
has in some instances been relieved by evacuating the water with a 
lancet, couching-needle, or trochar. 

Dropsy of the Spine. — This affection is mostly congenital; it 
consists of a soft fluctuating tumor on the spine, from fluid accumu- 
lated within the coats of the spinal cord, protruding externally in con- 
sequence of some portion of the vertebra! column being defective. It 



256 PATHOLOGY AND THEE AP £ UTICS. 

is generally fatal, although a cure has taken place spontaneously in a 
few instances, and several cases have been reported as cured by re- 
peatedly puncturing the sac with a fine needle. With the exception 
of this surgery, if deemed advisable, the proper course is to attend to 
the general health, and " trust to nature." 

Dropsy of the Chest — Hydrops Thoracis. — In this affection 
the fluid may accumulate in the cavity or cavities of the pleura on one 
or both sides, or in the mediastinum, or pericardium, or even the cel- 
lular texture of the lungs. These distinctions, however, are neither 
possible to ascertain during life, nor important practically. 

Symptoms. — With a constant sense of oppression in the chest, there 
is difficult breathing on exercising or reclining ; the countenance is 
more or less livid ; the urine scanty and high colored ; the pulse is ir- 
regular; the extremities are cedematous; the patient is often troubled 
with startings and palpitations during sleep; a distressing feeling of suf- 
focation frequently attends; and the patient can get no rest but in the 
erect posture. It usually attacks persons in advanced life. 

Special Causes. — Hypertrophy of the heart, aneurism, scirrhus of 
the stomach and liver, and other organic derangements, frequently pro- 
duce hydrothorax. When idiopathic, if ever, it is produced by the 
common causes of dropsy. 

Treatment. — In a majority of cases our prognosis must be unfavora- 
ble ; the derivative baths, and the principles already adverted to as ap- 
plicable to the treatment of dropsy in general, are all our gi-ounds of 
hope in the case before us. Some few cases are reported in medical 
works as having been caused by paracentesis thoracis — an operation 
which will be described in the surgical department of this work. 

Dropsy of the Abdomen. — Ascites, or dropsy of the belly, is 
called encysted, when the fluid is contained in a cyst or sac of adven- 
titious formation, instead of accumulating in the cavity of the abdomen 
itself. 

Symptoms. — It is known by an equal, tense, and heavy intumescence 
of the whole belly, which distinctly fluctuates to the hand, upon a 
slight stroke being given to the opposite side. 

Diagnosis. — In the encysted form the size of the abdomen enlarges 
gradually and steadily, without experiencing any sudden increase, de- 
crease, or change in the swelling ; whereas the distention is often tem- 
porarily diminished by treatment or accidental causes, when the accu- 
mulation is within the cavity of the abdomen; from ovarian dropsy, by 
the intumescence commencing lower down and on one side in the 



DROPSICAL DISEASES. 257 

latter disease; from tympanites, by the dullness on percussion, and by 
the fluctuation ; from retention of urine, by the dribbling of water in 
the latter affection ; from pregnancy, by the fluctuation, and state of the 
menses and breasts ; and from cysts or hydatids of the liver, by the 
swelling in the latter case being more circumscribed, and commencing 
on one side of the upper part of the abdomen. 

Special Causes. — Repelled eruptions, or exanthems, very frequently 
produce this disease. Mercurial ointments, lead washes, and other 
discutient and repellent lotions and medicaments, have often changed 
the morbid action from an external skin disease to an internal dropsy. 
Suppressed catamenia and metastatic gout are also frequent causes; and 
it is often symptomatic of diseased or disorganized liver, kidneys, and 
other organs. 

Treatment. — The encysted variety cannot be cured without the 
operation of tapping the abdomen. The general health should always 
be improved as much as possible before the operation is performed, 
for which purpose the packing, douche, and foot-baths are necessary. 
Surgeons are always apprehensive of danger from inflammation at- 
tacking the punctured part, but the danger chiefly arises from the in- 
flammatory or feverish state of the body, or the obstructed condition 
of the excretories at the time of the operation. If the general sys- 
tem is put in good condition, the simple operation of drawing off the 
water by tapping can seldom be serious, much less dangerous. 

When the watery fluid is collected within the peritoneum an opera- 
tion is sometimes necessary ; but ft equently it can be cured by the 
general plan of management applicable to cellular dropsy. The abdo- 
minal bandage, well covered and renewed five or six times a day, and 
a free use of injections, are specially desirable in this form of dropsy. 

Ovarian Dropsy. — Dropsy of the ovary is always of the encysted 
character, and the cysts are generally combined with enlargement of 
the ovary itself, which becomes converted into a hard, whitish, cartila- 
ginous mass. 

Symptoms. — The tumor commences on one or both sides of the 
iliac region, and gradually spreads over the abdomen; its surface is 
unequal, and its fluctuation is obscure and feeble, and in some cases en- 
tirely imperceptible. The general health is at first but little impaired. 

The causes of ovarian dropsy are similar to those of ascites, and the 
remedial processes must be conducted on the same general plan. Tap- 
ping should never be resorted to until the increasing distention begins 
seriously t<r affect the general health ; the operation cannot be relied 
on to offer a permanent cure, but with attention to the general health, 



258 PATHOLOGY AND THERAPEUTICS. 

may keep it in check so that the patient may enjoy comfortable health for 
an indefinite period. In many cases the operation requires to be re- 
peated several times. Extirpation of the ovary has been successful in 
a few cases ; but the majority have not long survived it. 

Fallopian Dropsy. — Dropsy of the Fallopian tube is extremely 
rare; in its early stage it is known by a heavy, elongated swelling of 
the iliac region, spreading transversely, with obscure fluctuation. The 
quantity of fluid is generally greater than that accumulated in the pre- 
ceding variety; and the prospect of cure is still less promising, although 
the same measures are applicable. 

Dropsy of the Womb. — This disease — the hydrometra of the old 
authors- is generally the result of some structural affection of the ute- 
rus. In some few cases, when the orifice of the uterus is closed, wa- 
ter collects in its cavity ; sometimes a large cyst, or cluster of hydatids, 
originating between its tunics, is discharged, accompanied with severe 
flooding; and occasionally the fluid accumulates in its cellular tissue, by 
which the organ is distended to an enormous size, while the whole 
abdomen appears anasarcous. 

Symptoms. — Heavy, circumscribed tumor or protuberance in the hy- 
pogastric region, attended with obscure fluctuation, and progressive!; 
enlarging; the mouth of the uterus is thin and yielding, and the com- 
plaint is unaccompanied with pregna-ncy or ischury. 

Treatment. — The general remedial plan is the same as the preceding 
varieties. "When the mouth of the uterus is closed, the water may be 
evacuated by the introduction of a cauula. 

Dropsy of the Scrotum — In some cases the fluid is contained in 
the tunica vaginalis, or surrounding sheath of the testis ; sometimes in 
the cellular membrane of the scrotum ; and in a third variety the fluid 
has accumulated in the tunica vaginalis of the spermatic cord. Con- 
genital hydrocele is that form of the disease in which the communica- 
tion between the cavities of the peritoneum and tunica vaginalis is in- 
closed, the fluid collecting within the latter. 

Symptoms. — The vaginal, or first named variety, is the proper hy- 
drocele. The intumescence is soft, transparent, and pyriform ; it is 
unattended with pain, and enlarges gradually. In some cases the tu- 
nic is so distended and transparent that a candle may be seen through 
its contents. 

Treatment. — In recent cases, very cold sitz-bnths and the ascending 
douche, each repeated several times a day, or refrigerating local appli- 



DROPSICAL DISEASES. 259 

cations of iceu-water or pounded ice, in connection with the genera] 
treatment recommended for the preceding cases, will often effect a 
cure. When the cast has been of long standing, the operation, to be 
described hereafter, will be necessary. 

Emphysema — Inflation — Wind-Dropsy. — This affection, which 
is caused by an accumulation of air in the natural cavities, differs from 
dropsy proper in the distention being elastic and sonorous. Sometimes 
the disease results from external injuries penetrating the lungs ; some- 
times the air is formed by a process of putrefaction or decomposition ; 
and sometimes it is secreted directly from the blood. 

Symptoms. — In the cellular variety — the pneumatosis of Sauvages — 
the distention is sometimes limited to particular parts of the body, and 
sometimes extends over the whole surface. It is marked by a tense, 
glabrous, diffusive intumescence of the skin, which crackles beneath 
the pressure of the fingers. When arising from a wound in the chest, 
which penetrates the lungs — traumatic emphysema — the inspired air 
may rush into the cavity of the chest, the cellular membrane of the 
lungs, and even become diffused throughout the areolar tissue, pro- 
ducing a universal inflation, which is attended with violent palpitation 
and extreme danger of suffocation. Occasionally the inflation is con- 
fined to one side of the chest ; it is then called pneumo-thorax ; and this 
form is sometimes produced by ulcerations which destroy some part of 
the pulmonary structure. When arising from fish-poison, mushrooms, 
or other venom, the disease is accompanied with extensive signs of pu- 
trescence and impending mortification. 

In tha abdominal variety — tympany — there is a tense, light, and 
equable distention of the belly, which distinctly resounds to a stroke of 
the hand. 

When the uterus is inflated with air, there is light, tense, circum- 
scribed intumescence in the lower part of the abdomen, obscurely son- 
orous, and accompanied with occasional discharges of wind through the 
mouth of the womb. 

Treatment. — All the varieties of the disease before us are, happily, 
veiy rare, with the exception perhaps of tympany, and this is mostly 
a symptomatic affection. The general plan of treatment is the same 
as for dropsy of the same structure or organs. In emphysema from 
wounded lungs, the operation of puncturing between the ribs is some- 
times attended with benefit, and the dripping-sheet, followed by dry 
rubbing or hand friction, is probably the best of the strictly hydrothera- 
peutic processes. When occasioned by poison, the wet-sheet, so man- 
eged as to produce moderate diaphoresis ; sips of iced-water, copious 



260 PATHOLOGY AND THERAPEUTICS. 

injections, etc., on the plan recommended for anatomical erythema, 
should be resorted to. In the abdominal and uterine varieties, copious 
cold injections by means of the pump and vaginal syringes, are to be 
frequently employed; the spray-bath and the ascending douche are 
also valuable assistants. 

Inflammatory Dropsy. — This term is rather awkward, but, un- 
fortunately, I cannot find in the whole range of pathological nomen- 
clature any more appropriate one ; and I do not care to invent new 
technicalities, especially as we have already a vast superabundance. 
The term comprehends the two diseases, elephant leg, which is pecu- 
liar to hot climates, and phlegmasia dolens, which is peculiar to lying- 
in women, both of which are characterized by a tense, diffuse, inflam- 
matory swelling of one leg. 

Symptoms. — In the tumid leg of childbirth, which has been variously 
denominated puerperal sivelled leg, bucnemia spar ganosis, phlegmasia 
dolens, phlegmasia laclea, ecchymoma lymphatica, anasarca serosa, cru- 
ral phlebitis, and cruvitis, the attack usually comes on in the second or 
third week after parturition ; the intumescence is pale, glabrous, equa- 
ble, elastic, and acutely tender; to the touch there is asensation of nu- 
merous irregular prominences under the skin, and it is accompanied 
with a constitutional febrile disturbance of the hectic type. In a ma- 
jority of cases the attack commences with pain in the groin of one 
side, accompanied with fever, and followed by a swelling, which ex- 
tends down the thigh and leg to the foot, and in a day or two the whole 
limb is double its natural size, hot, smooth, exquisitely tender, and 
moved with great difficulty. The fever usually begins to decline in 
two or three weeks, but in some cases runs for six or eight weeks, 
causing extreme emaciation. In a very few instances both limbs are 
affected simultaneously ; and in still rarer instances the arms have been 
attacked ; in many cases the affected limb has remained enlarged and 
weak through life. It may be added here that a disease very like the 
one before us, if not identical, has sometimes affected the male sex. 

The second variety, the Barbadoes leg, bucnemia tropica, elephant 
leg, is common to hot climates, especially the West Indies, Arabia, and 
the Polynesian Isles, where it is called yava-skin, from the supposition 
that it is caused by drinking a heating beverage called yava ; "and like 
the gout among ourselves," says Dr. Good, "is regarded in a sort of 
honorable light." It is known, however, in temperate climates, and a 
few cases have occurred in the United States. The limb is hard, livid, 
and enormously misshapen ; the skin is at first glabrous, but afterward 
becomes thick, scaly, and warty ; in some places bulging out, and in 



DROPSICAL DISEASES. 2ol 

others deeply indented ; the attending fever is irregularly erratic and 
intermittent, which eventually subsides, and the disfigured limb be- 
comes insensible, and only troublesome from its weight and bulk, which, 
however, is regarded in some semi-civilized countries as a badge of 
honor, as the gout is in places where the inhabitants pretend to be 
wholly civilized. 

Special Causes. — The puerperal variety is unquestionably owing to a 
condition of body which may significantly be termed the constipated 
diathesis. The general pressure on the blood-vessels and lymphatics 
during pregnancy, and the inflammatory condition of the whole system, 
which are the common consequences of the ordinary method in which 
females are fed and doctored through pregnancy and delivery, are ex- 
actly calculated to produce this and many other diseases of the lying-in 
period. The complaint under consideration, though very common in 
allopathic practice, has never been known, and probably never will be, 
where the patient has, through the term of gestation, lived and bathed 
hydropathically. 

The second variety is as clearly among the penalties which merci- 
less and unrelenting nature has attached to the use of debilitating stim- 
ulants, and impure, unhealthful, aud obstructing food, with inattention 
to the subject of a clean skin. 

Treatment. — Puerperal swelled leg must be treated precisely as an 
acute inflammation. The wet-sheet pack, or frequent tepid ablutions 
of the whole body, and the constant employment of cold wet com- 
presses to the local affection, are the leading measures of treatment ; 
cold water may be freely drank ; and cool injections are generally nec- 
essary. The food must be of the kind called " fever die£^ in this work. 

Medical authors — and they have elaborated many ponderous treat- 
ises on the subject — are singularly at variance, and as it appears to me, 
singularly foolish, in their notions of the nature and treatment of this 
disease ; while their practice, or the disease under their practice, or 
(he patient under both, has been singularly unfortunate. 

The second variety can only be successfully medicated in its early 
stage. The pack and dripping-sheet, the leg-bath and leg-douche are 
the most important processes, with due attention to simplicity and pu- 
rity of food. Amputation has been tried, but in most cases tetanus, or 
a gangrenous ulcer has followed ; perhaps, however, because the gen- 
eral health was not duly cared for previously to performing the opera- 
tion. 



262 PATHOLOGY AND THERAPEUTICS 



CHAPTER XIV. 

DISEASES OF MIS-OSSIFICATION. 

The title of the present group of diseases is taken from the most 
prominent symptom, which, though indicative of an excess, deficiency, 
or mat-assimilation of the bony structure, does not very well express 
the essential nature or proximate cause. It includes : 

Rickets — Rachiii — Rachitis. 
Cretinism — Cyrtosis — Cretinismus. 
Mollities Ossium — Softening of the Bones. 
Fragilitas Ossium — Brittleness of the Bones. 
Osthexy — Ossification of soft Structures. 
Exostosis — Bony Tumor. 

Rickets. — This disease is probably of modern date. The first ac- 
count we have of it was published by Glisson, as it occurred in England 
in the middle of the seventeenth century. 

Symntoms. — The malady sometimes exists at birth, but more fre- 
quently the first indications are observed from about the eighth month 
to the third year. It is preceded by a paleness and puffiness of the 
countenance, and a yellow, sulphur hue of the cheeks ; the body at 
length emaciates, the flesh becomes flaccid, the lower limbs grow thin, 
while the head increases in bulk, the forehead becomes prominent, the 
spine bends, the belly is tumid, and the joints are loose and spongy 
The mental faculties are usually clear and often precocious. 

Special Causes. — Hooper says the causes of this disease are, "bad 
nursing, bad air, bad food, want of cleanliness." It is certainly the 
most philosophical discourse on cetiology I have ever read in an allo- 
pathic book. He might have gone farther back, and told us as truth- 
fully that bad air and bad food, and inattention to personal cleanliness on 
the part of one or both parents, produce the predisposition to it — the 
rachitic diathesis. 

Treatment. — One or two daily ablutions, pure air, plenty of sun- 
shine, good mother's milk, abundant cold water-drinking, and brown 
bread, hominy, wheaten grits, potatoes, aud good fruits, are all that 
need be named among the remedial agencies. More or less deformity 
will always exist. 



DISEASES OP MIS-OSSIFICATION. 263 

Cretinism. — The essential differences between this disease and the 
^receding, are the tendency to goitre or enlargement of the thyroid 
gland, and the small size of the brain, with thick skull bones, which 
characterize the present affection. 

Symptoms. — The bony derangement chiefly affects the head and 
neck ; the body is stinted; the skin is wrinkled; the complexion is 
wan; the countenance is vacant and stupid; the cranium bulges out, 
particularly in the occipital region, while the crown and temples are 
depressed ; the sensibility is blunted ; all the mental faculties are feeble 
or idiotic; the moral affections seem to be wholly wanting; and a ma- 
jority of the miserable sufferers are both deaf and dumb. 

Special Causes. — Cretinism was first noticed about the same time 
that rickets first appeared ; it has prevailed severely in the low lands 
of Switzerland, in the secluded valley3 of the Alps, and other damp, 
shaded, or confined places; hence the causes of rickets and cretinism 
cannot be essentially different, nor need we add any thing to the 
treatment named for the former. 

Mollities Ossium. — A general flexibility of the bony structure, 
formerly denominated spina venlosa, is commonly found in the early 
periods of life, as fragility or brittleuess is peculiar to later age. Its 
immediate cause is, of course, deficient assimilation of osseous mate- 
rials, buc its more remote and more important cause must lie farther 
back, in some derangement of the primary nutritive functions. 

Symptoms. — A bending or crooking of the bones in different parts 
of the body, on slight exertion, with little or no pain. 

Treatment. — Medical books, in consideration of the deficiency of 
earthy matter in the bones, have undertaken to remedy the difficulty 
by introducing phosphate of lime, alkaline carbonates, etc., in liberal 
doses, into the stomach; and, although such practice may seem very 
reasonable to those who cannot look beyond a chemical fact to a phy- 
siological law, it has never, to my knowledge, been productive of the 
Jeast benefit. The rational curative measures are the same as for 
rickets. 

Fragiutas Ossium. — In this affection the substance of the bones 
becomes so brittle that it is apt to break on slight exertions. The im- 
mediate cause is a deficiency of the materials of the gelatinous struc- 
ture ; and the general treatment is the same as for the preceding 
variety. 

UsTHExr. — This term imports an ossific diathesis, a bony habit of 



264 PATHOLOGY AND THERAPEUTICS. 

body. The disease consists in a superfluous secretion and deposit of 
ossific matter, by which th» soft parts are more or less indurated or 
obstructed. 

Authors divide this affection into the parenchymatous and vascular 
varieties, as the bony material accumulates in the substance of organs, 
or in the coats or membranes of vessels. The kidneys and bladder are 
most liable to calculus concretions, for the reason that they are espe- 
cially designed to secrete from the blood and expel from the body the 
greater portion of effete alkaline and saline matters ; hence gravel and 
stone may result from too great a portion of earthy material in the 
food, or from deficient elimination of its excess in consequence of 
functional obstruction or debility. Ossific deposites are also occasion- 
ally found in the brain, lungs, thymus gland, substance of the heart, 
structures of the eye, muscles, etc. The vascular form most fre- 
quently affects the aorta or other large arteries, and the mitral valves; 
but in some instances the pleura and other membranes, the trachea, and 
various cartilaginous structures ossify. In all these cases the symp- 
toms are exceedingly obscure, and the treatment cannot be better 
expressed than by the general phrase — attention to the general health. 

Exostosis. — Calculous or bony tumors may be seated immovably 
on a bone, or on the periosteum, or pendulously in a joint, or fixed or 
movable in some fleshy part of the body. These affections are gen- 
erally sequela? of gout, rheumatism, syphilis, etc., but sometimes appear 
in persons of ordinary, though, of course, not perfect health. They are 
all cases for surgical treatment, and are only to be cured by extirpation 
or amputation. 



CHAPTER XV. 

DISEASES Ot SENSATION 



The diseases of the present group are somewhat incongruous in a 
nosological point of view; but as they are susceptible of a generic 
definition, no direct violation of pathological propriety is committed in 
the arrangement. They may be distinguished by darting or local 
pains, occurring in paroxysms with irregular intervals, or by perverted 
sensation, without fever, inflammation, or structural change. 

They are all symptomatic of nervous exhaustion, functional obstruc 



DISEASES OF SENSATION. 265 

tion, malformation, or local accident or injury ; and it is only when the 
primary morbid condition is too obscure to be recognized, that they 
are to be treated as idiopathic maladies. The following are all that 
require special consideration : 

Cephalalgia, Syncope, 

Neuralgia, Morbid Sight, 

Sleeplessness, Morbid Hearing, 

Restlessness, Morbid Smell, 

Antipathy, Morbid Taste, 

Vertigo, Morbid Touch. 

Cephalalgia — Cephalgia — Headache.— The unbiassed and in- 
telligent student, who will diligently labor through the various attempts 
which have been made by medical authors to define, describe, arrange, 
classify, expound, and medicate the single and seemingly simple sub- 
>ect of headache, will find enough of confusion confounded to convince 
him that a system, as baseless as the fabric of a vision, has engaged the 
minds of many medical philosophers, rather than a careful and correct 
observation and arrangement of the phenomena of truth, nature, and 
common sense. The ordinary and every day causes of headache are, 
indigestible food, overloaded stomach, constipated bowels, torpid liver, 
inactive kidneys, obstructed skin, oppressed lungs, acidity, flatulence, 
violent passions, suppressed natural evacuations of all kinds, and their 
consequences, thick blood, irregular circulation, etc., etc., to which 
may be added the direct effect of stimulating drinks or nervines, or 
their sudden withdrawal after the system has been accustomed to their 
use. And the pain of headache will be acute, chronic, periodic, throb- 
bing, local, or general, etc., according to a multitude of circumstances 
which bear upon each individual case. All this is plain and straight- 
forward. But let us see what the books say. Much learning has 
surely made them mad. Thus Sauvages divides headache into acute, 
chronic, and partial ; the acute he subdivides into plethoric, catamenial, 
hemorrhoidal, dyspeptic, febrile, throbbing, intermittent, puerperal, in- 
flammatory, catarrhal, nervous, hysterical, and the metallic ! the chronic 
he subdivides into syphilitic, scorbutic, arthritic, remittent, melancholic, 
plicose, and serous ; and the partial he subdivides mto jiains in eyes, sock- 
ets, and frontal sinuses, purulent, nephralgic, and the lunatic hcmicrania. 
Frank divides headache into four species, cephalalgia, cephalcea, hemi- 
crania, and clavus ; and in respect to their nature he subdivides these 
into inflammatory, rheumatic, gastric, arthritic, scorbutic, periodic, scrofu- 
lous, carcinomatous, syphilitic, and nervous. Dr. Good divides head- 
ache into tlupid, chronic, throbbing, megrim, and sick. Dr. Burder 
11—23 



EC6 PATHOLOGY AND THERAPEUTICS 



divides headache into muscular, periosteal, congestive, organic, dyspep- 
tic, and periodic. Dr. Weatherhead divides headache into dyspeptic, 
nervous, plethoric, rheumatic, arthritic, and organic. Dr. Copland 
divides headache into nervous, congestive, plethoric and inflammatory, 
dyspeptic and bilious, cerebral, pericranial or neuralgic, rheumatic and 
arthritic, periodic, hypochondriacal, and the sympathetic. Dr. Hooper 
divides headache into internal and external ; the former being subdi- 
vided into congestive, sympathetic or dyspeptic, and organic ; and the 
latter into muscular, periosteal, and neuralgic, etc., etc. 

The same confusion prevails among medical authors with respect to 
the pathology and treatment of this complaint. 

Treatment. — Whether idiopathic or symptomatic, all severe head- 
aches require prompt and special palliative medication, although the 
cure must be sought in the removal of the morbid condition on which 
they depend. The majority of cases can be relieved at once by put- 
ting the feet in warm water, and applying cold wet cloths to the head. 
The hot fomentation to the abdomen is often sufficient. When arising 
from suppressed menstruation the warm hip-bath is advisable. When 
the cause is a sudden oold, the wet-sheet pack should be employed. 
If the stomach is exceedingly irritable, and troubled with obstinate 
nausea and vomiting, warm water-drinking and the pouring head-bath 
constitute the most efficacious practice. When arising from the sud- 
den abstraction of stimuli, as of wine, tea, coffee, tobacco, etc., the 
patient should keep very quiet for several days, and walk, sit, or lie 
down, as he finds most comfortable, and take frequent warm foot and 
cold head-baths, waiting patiently for nature to restore the natural sen- 
sibility and tone of the organism, so that its machinery can work again 
without the lash of artificial stimulation. 

Neuralgia — Nerve-ache. — Neuralgia is another of those dis- 
eases which are among the growing evils of the increasingly enervat- 
ing customs of civilized society. Until a very modern date, the only 
form of this disease known to medical men was the tic dolorcux, or 
neuralgia of the face ; now, however, neuralgic pains, in almost all 
parts of the body, are very common afflictions. The face, jaws, feet, 
und breast, are, however, most frequently the parts affected. 

Symptoms. — The disease is recognized by acute lancinating pains, 
along the course of one or more nervous branches of the organ or 
part affected, which recur in short paroxysms, with irregular intervals ; 
usually there is more or less twitching or irregular convulsive motion 
of the adjoining muscles. In facial neuralgia the pain shoots from the 
region of the mouth to the eyes, cars, cheek, palate, fauces, and teeth, 



DISEASES OF SENSATION. 267 

sound teeth have sometimes been extracted on the supposition that 
some concealed ulcer or caries occasioned the pain. When the foot 
is attacked, there are racking pains about the heel, darting toward the 
aukle and bones of the tarsus. In nerve-ache of the breast the sharp 
darting pains usually divaricate from a fixed point in the breast, and 
shoot down the course of the ribs and arm to the elbow. When 
other parts, organs, or particular muscles are attacked, the disease is 
easily recognized by the sharp, darting, cutting, and intermitting char- 
acter of the pain. 

Special Causes. — All the causes of dyspepsia, and every thing con- 
ducive to nervous debility, are among the causes also of neuralgia. 
Those enervating influences which more especially predispose to this 
disease are tea, coffee, alcohol, tobacco, excessive brain labor, and de- 
pressing emotions, as grief, fear, anxiety, suspense, disappointment, etc. 

Treatment. — I know not upon what principle our allopathic friend 
propose all the most virulent poisons of their materia medica for tiie 
treatment of neuralgia, unless it is that the more powerful the pain the 
more potent should be the poison ; or in other words, the more a pa- 
tient suffers from disease, the more he should be made to suffer from 
drugs. Arsenic, belladona, Prussic acid, henbane, strychnine, opium, 
quinine, etc., etc., in terrific doses, are put forward as the most prom- 
ising remedies, while surgery comes in and kindly offers to interrupt 
the morbid sensibility by dividing the affected nerves between their 
point of distribution and the common sensorium. 

The disease before us appears under so many complications that the 
most experienced hydropath will have to feel his way in the majority 
of cases. Every circumstance affecting the general health must first 
be inquired into and placed under organic law. Usually some one of 
the excretories will have been for a long time torpid, and frequently 
the bowels, skin, kidneys, and liver are all obstructed. The majority 
of patients we meet with, too, will be worn down with suffering, and 
poisoned through and through with drugs, or farther reduced by de- 
pletions, as bleedings and blisterings ; hence they will generally be ex- 
ceedingly tender and susceptible. 

The treatment should generally begin with gentle bathing in tepid 
or warm water, followed by moderate friction or hand-nibbing. The 
temperature of the water should be reduced as fast as possible — taking 
care, however, to avoid aggravating the pain by a sudden chill — consist- 
ently with securing a comfortable glow after each application. In some 
few cases, where the external heat and capillary circulation are not 
materially deficient, cold, and even very cold water, is more sedati've and 
agreeable than tepid or warm. Local baths, as compresses, half, hip, 



268 PATHOLOGY AND THEEAP5UTICS. 

and foot-baths, should be first employed, followed by the half or full 
pack, dripping-sheet, plunge, and douche, as the morbid sensibility 
diminishes and the strength improves. In many cases there is a kind 
of sub-paralysis of the limbs, or a rheumatic lameness and rigidity of 
the muscles of the affected part ; in these cases the warm douche, fol- 
lowed by the cold dash, is excellent. 

Sleeplessness. — This affection, which is characterized by a diffi- 
culty or inability of sleeping, is, when not symptomatic, produced by 
some mental- excitement or bodily disquiet. In the former case the 
mind is listless to surrounding objects; and iu the latter the attention is 
alive to them. Severe study, intense attention to business, and pro- 
tracted watching, are common causes of the former variety, and cold 
feet, eating near bed-time, taking stimulating drink in the evening 
when unaccustomed to it, or abstaining after having been habituated 
to it, are the ordinary causes of the latter. The remedies are a hip- 
bath or dripping-sheet at bedtime, when the trouble arises from men- 
tal-causes ; and the warm foot-bath, abdominal girdle, active out-door 
Walking, and exercising in a cold room while in a state of nudity — a 
form of air-bath — when the causes are corporeal. 

Restlessness. — There are two states of general bodily disquietude, 
which authors have regarded as distinct diseases. One is familiarly 
called fidgets, and distinguished by a perpetual desire to change the 
bodily position; and the other, called anxiety, is known by an equally 
restless desire of perpetual locomotion. The common cause of the 
fidgety variety is too long confinement of the whole body, or any part 
of it, in a nearly motionless position. Children at school, writers at 
the desk, females with the needle, especially those of active brains and 
irritable temperament, often suffer severely for want of free and fre- 
quent exercise of the whole muscular system. Worms and some kinds 
of skin diseases sometimes produce this complaint. 

The anxious form of restlessness is peculiar to persons of a highly 
nervous temperament, and is attended with a distressing or uneasy 
sensation, particularly about the pracordia. Constipation is a frequent 
cause in acutely irritable persons, and difficult, local, or pecuniary cir- 
cumstances, or projects in relation to the future, on which the mind 
dwells intensely, are among the most frequent of the mental causes; 
and our medication must be directed to the removal of the existing 
cause, whatever that may chance to be. 

Antipathy. — A feeling of interne repugnance or horror at the 



DISEASES OF SENSATION. 269 

presence of particular objects, or the introduction of particular sub- 
jects, constitutes one of the many singular infirmities of our fallen na- 
ture. Some persons will sicken at the sight or taste of nutter or cheese ; 
some find the smell of roses and mint, or the sound of music, painfully- 
disagreeable ; some will detect the presence of a cat in the room with- 
out the use of the external senses ; some are ready to faint at the sight 
of blood, wounds, sores, crabs, lobsters, toads, vipers, and other un 
sightly animals ; and some will scream frightfully at the appearance of 
a mouse or spider. Probably these peculiar traits of idiosyncrasy may 
be produced by frights or other accidents in early life, or by some pow- 
erful and perhaps forgotten mental impression of the mother during 
the period of gestation. The only chance of cure seems to be, in 
gradually accustoming the patient to the object of antipathy. 

Vertigo. — Different forms of vertigo are known by the terms diz- 
ziness, swimming of the head, blind headache, and nervous J amting fit ; 
it is a frequent accompaniment of headache, and is owing to the same 
exciting and predisponent causes. 

Symptoms. — The patient, while at rest, experiences an illusory gy- 
ration, or objects around him seem affected with a whirling motion ; 
there is also a sense or fear of falling, with some degree of mental con- 
fusion. In scfme instances the dizziness is combined with illusory 
sounds, as whispering, murmuring, ringing of bells, beating of drums, 
roar of cannon, etc. 

Special Causes. — The immediate cause or proximate condition is a 
preternatural pressure of blood upon the nervous substance of the 
brain ; and this is owing in most cases to a morbid viscidity of the blood 
from retained bile, perspirable matter, or other effete material. 

Extreme debility, whether from hard labor, starvation, hemorrhage, 
or protracted diseases, favors the condition of the brain from which ver- 
tigo results, for the reason that the action of the heart being weakened 
and the capillaries contracted or paralyzed, the blood is pressed with 
disproportionate force upon the brain. The exciting causes are usually 
sudden exertion or hurried motion, as raising the head, stooping, etc. 
Any considerable motion to which the body has never been accustomed, 
as sailing, swinging, walking circularly, sitting backward in a carriage, 
etc., may occasion vertiginous sensations in healthy persons. Intoxica- 
tion, narcosis, and violent fear also produce dizziness, which is experi- 
enced on every attempt at motion. 

Treatment. — When the body is full and plethoric, or there are evi- 
dences of biliary accumulations, a warm water emetic is advisable. In 
all cases the bowels must be kept entirely free by plain, coarse food, 



270 PATHOLOGY AND THERAPEUTICS. 



and injections if necessary ; and the skin kept open by one or two 
thorough daily ablutions. In other respects regard must be had to the 
idiopathic condition. When connected with great debility, emaciation, 
loss of blood, or inanition, quiet and sleep are among the leading reme- 
dial agencies. 

Syncope. — Sivooning and fainting-fit are the principal varieties of 
the malady before us, which is distinguished by diminished sensibility, 
inability of utterance, with feeble or imperfect motion of the heart and 
lungs. The general causes are the same as those of the preceding 
disease, although to the exciting causes may be added extreme pain, 
violent passions, sympathy, sudden fright, sudden abstraction of blood, 
rapid evacuation of fluid accumulated in the cavities of the body, as in 
dropsy, sudden discharge of the matter of extensive abscesses, retro- 
cession of arthritic and eruptive diseases, excessive fatigue, etc. The 
treatment consists of a free current of cold air; sprinkling cold water 
in the face ; and if the syncope is prolonged, pouring cold water over 
the head, and applying the cold compress to the stomach; to which 
may be added the recumbent position, fig. 189, and warm water with 
friction to the lower extremities. As soon as the patient can swallow 
a draught of cold water should be administered. 

Fig. 189. 




POSTURE IN SYNCOPE. 

Dr. Good says — T quote to contrast, not to commend his treatment : 
" As soon as the patient is capable of swallowing, some spirituous cor- 
dial, a glass of wine, brandy and water, fetid tincture, or the aromatic 
spirit of ammonia, or of ether, should be administered." The reader 
need not be told that a half gill of pure soft water is an ample substi- 
tute for sll of the above allopathic notions.- 

Morbid Sight.— Ingenious nosologists have certainly displayed 
more analytical than philosophical talent in giving us a list of nearly 
six hundred diseases of the eye ! Dr. Good has reduced the formida- 



DISEASES OF SENSATION. 271 

b.» .ist to twelve ; but I think one will answer just as well for all the 
forms of depraved vision which do not properly beloug to the special 
chapter on diseases of the eye. 

Symptoms. — In false sight or illusory vision — the only species coin- 
ing within our generic definition — imaginary objects float before the 
eye, or real objects appear with imaginary qualities, constituting the 
ocular specters and the muscts volitanles of authors. In many cases of 
false sight, objects appear of unusually large or small sizes, or multi- 
plied in number ; one color is mistaken for another ; sparks and flashes 
of light appear before the eyes. etc. 

Special Causes. — Excess of light, plethora, local injuries, as blows, 
bruises, congenital malformations. 

Treatment. — But little can be done therapeutically beyond attention 
to the general health. Gentle friction and manipulation, frequently 
holding the eyes in cold water, etc., as in the case of weak eyes, or 
sore eyes from debility, are occasionally serviceable. It is especially 
important in all cases of depravity of the special senses, that grease, 
salt, and all earthy or saline matters be excluded from the food and 
drink. 

Morbid Hearing. — Preternatural acuteness or obtuseness, or dis- 
ordered perception of sound, results from a variety of inflammatory 
states or structural changes of the ear. But in some instances the 
hearing has been so keen as to render the ordinary whispering, and 
even the respiration of persons present highly distressing, and to render 
real, imaginary, or illusory noises exceedingly troublesome, or so dull as 
to disable the patient from taking part in common conversation, without 
any apparent local affection of the auditory apparatus ; although in 
most cases it is presumable that a deficiency of the ceruminous secre- 
tion, or an unnatural irritability or torpor, resulting from powerful 
noises, violent passions, etc., are the conditions on which the depravity 
of the function depends. In some cases of semi-paresis, or partial 
palsy of the auditory nerve, the ear is only sensible of articulate 
sounds, when excited by louder sounds intermixed with them ; and in 
some cases particular sounds, as the beating of a drum, the rattling of 
carriage wheels, the tones of a shrill pipe, the ringing of bells, etc., 
will excite the function and enable ordinary conversation to be recognized. 

Treatment. — Hemedially, we can only attend to the secretion of the 
external ear, and to the general health. Frequently syringing the ex- 
ternal meatus with warm or tepid water, followed by cool or cold, and 
the occasional employment of the head-bath, with a moderate douche 
to the upper portion of the spine, are the appropriate local measures. 



272 PATHOLOGY AND THERAPEUTICS 

Morbid Smell. — Acrid, obtuse, and absence of smell are, like 
analogous conditions of the other senses, usually among the symptoms 
of fevers and local affections. But with some an extreme and painful 
keeness or total deprivation of the sense exists from birth. Some per- 
sons find the smell of roses, and various odors and perfumes which are 
agreeable to the majority, intolerably offensive and sickening. A tem 
porary loss of smell may result from a slight cold ; and a permanent 
depravation or deprivation of the sense is often produced by irritants, 
pungents, errhines, and poisonous vapors, as " cephalic snuffs," tobacco 
dust, cigar smoke, etc. Catarrhal affections, when long continued, 
always deteriorate the sense, and all high-seasoned dishes and compli- 
cated preparations of animal food, are especially injurious. 

Treatment. — The head-bath, and the frequent sniffing of cold water 
up the nostrils, with a rigidly simple diet, constitute the special thera- 
peutic measures. 

Morbid Taste.— The tongue and palate, which in the normal 
state distinguish the chemical and gustatory qualities of substances, as 
sour, sweet, bitter, rough, aromatic, saline, etc., are sometimes so 
malformed originally, or so perverted by disease or bad dietetic habits, 
as to be painfully acute or morbidly obtuse ; to remedy which nothing 
is more appropriate than frequently holding cold water in the mouth, 
and employing an exclusively farinaceous and fruit diet, the farinaceous 
part to be as simple and dry as possible, of which unleavened brown 
bread is the best specimen. 

Morbid Touch.— The hand, and especially the extremities of the 
fingers, possess the nicest power of discriminating the tangible proper- 
ties of bodies, although the whole skin belongs to the organ of feeling, 
or sense of touch ; and this sense, like all the others, may be preter- 
naturally acute, or insensible, or illusory. Its principal deviations from 
the normal condition are known as soreness, itching, heat, and coldness. 
The first variety is usually the result of a cold, or a symptom of fever 
or inflammation; the second is dependent on irritation in the stomach, 
bile in the blood, or imperfect depuration from the skin; and the third 
and fourth are caused by exercise, and alternations of, or exposures to, 
extreme temperature. Beyond a daily cold-bath, and attention to any 
particular local derangement that may chance to exist, we have nothing 
to say remedjally, except advise a regulation jf all the voluntary habite 
according to the laws of health. 



MENTAL D [SEASES. 



278 



CHAPTER XVI. 



MENTAL DISEASES. 



The i elation between mind and body is so intricate and intimate that 
a morbific impression upon either may produce a manifestation of mor- 
bid phenomena in the other. The majority of cases of insanity, luna- 
cy, hallucination, or mental aberration, have their origin in bodily dis- 
ease ; yet there are some cases in which the producing cause is pure- 
ly mental. The present chapter comprises a group of maladies whose 
most prominent symptoms are abnormal manifestations of the mental 
operations, irrespective of the nature of the predisponent, proximate, 
or exciting causes. They may be arranged in tabular form as follows : 



Insanity 

Ungovernable 
Passion 

Hallucination 



Melancholy, 
Madness. 

Fury, 

Despondency, 

Hair-Brained. 

Sentimentalism, 

Hypochondriacism. 



Revery 

Sleep Dis- 
turbance 

Fatuity 



Absent-Mindedness, 
Mental Abstraction, 
Brown Study. 

Somnambulism, 
Sleep-Talking. 



< Irrationality, 
(. Imbecility. 



Insanity — Craziness.— Nothing in the whole range of pathology 
is more difficult than a nosological arrangement of the abnormal states 
of mind ; for the vast diversity of human intellect, and the varied cir- 
cumstances of excitement, depression, and mis-direction to which it is 
subjected by individual and social uses and abuses, make it sometimes 
impossible to say where sanity ends and insanity begins; while among 
the unquestionably insane we ind every conceivable shade and degree 
of mental peculiarity, from a disproportionate activity of a single fac- 
ulty or propensity, constituting a one-ideaism or an all-absorbing ^>as- 
sion, whose possessor is merely a monomaniac, to the most violent and 
extreme derangement of several or of all the mental powers, consti- 
tuting craziness, lunacy, or idiocy. 

The malady before us presents two distinct features, which authors 
have ranked as species of disease : melancholy, in which there is a to- 
tal or partial hallucination, accompanied with extreme dejection, fear, 
and false apprehensions, while the will is wayward and domineering; 



274 PATHOLOGY AND THERAPEUTICS. 



and mania or madness, in which al! the mental powers are greatly ex- 
cited, and the discrepance between perception and judgment general. 
Melancholy is subdivided into many varieties, as gloomy melancholy, 
when the patient is mute and retiring ; erratic, when he is roving and 
restless ; malevolent, when he is morose or mischievous, and disposed 
to injure himself or others ; and complacent, when he is quiet, affiible, 
and visionary. Madness is characterized as furious, when the patient 
is violent, runs, jumps, mutters, cries, shrieks, etc. ; elevated, when he 
is gay, lively, hurried, exulting in his own imaginary importance, which 
may make him a president, king, prophet, or the Messiah; despond- 
ent, when he is abjected and depressed; and demented or chaotic, 
when the mind sinks into insensibility and forgetfulness, with an entire 
abolition of the faculty of judgment, yet possessed of unconnected and 
evanescent emotions, and perpetually active in acts of extravagance 
without object or design. 

Special Causes. — It is natural enough that physicians, considering 
how few are the sound physiological principles known in the schools of 
medicine, should suspect some morbid condition of the brain or its ap- 
pendages as the special cause of all diseases which are characterized 
by disorderly manifestations of the mental functions. But says Dr. 
Good : " Concerning therefore the remote or even proximate cause of 
the disease, we have yet much to learn. From the view we have 
taken in the proem of the close connection between the mind and the 
brain, it seems reasonable to conceive that the remote cause is ordina- 
rily dependent upon some misconstruction or misafTection of the cere- 
bral organs ; and hence every part of them has been scrutinized for 
proofs of so plausible an hypothesis, but Yitherto to no purpose what- 
ever. The form of the cranium, its thickness, and other qualities ; the 
meninges, the substance of the brain, the ventricles, the pineal gland, 
the commissures, the cerebellum, have all been analyzed in turn by 
the most dexterous and prying anatomists of England, France, Germa- 
ny, and Italy, but with no satisfactory result." 

As well might we expect to find the proximate cause of a disorderly 
communication or action of the telegraphic machinery, by a chemical 
analysis of the wire between the batteries nr at the stations, as to seek 
the cause of diseased mental manifestation in an analysis of the anatom- 
ical character of the brain. The nervous influence and the electric 
fluid will probably forever elude all attempts at material analysis. 

That the phenomena of insanity immediately depend on some excess 
or defect, or mal-distribulion of nervous influence, is sufficiently obvi- 
ous ; nor is it difficult to ascertain the ordinary, remote, or disturbing 
causes; these are generally strong menta. enrotions, operating in con- 



MENTAL DISEASES. 275 

nection with an organism physiologically unsound. Intemperance is 
the most frequent cause. Gluttony, self-abuse, powerful stimulants, 
religious excitement, grief, fear, disappointment in objects of love, am- 
bition, or property, reverse of fortune, etc., are named by authors 
among the ordinary causes. 

Treatment. — The moral management will be readily suggested by 
the circumstances of each case. Undoubtedly a well-ordered public 
asylum is die proper place for the majority of becrazed invalids. But 
there the ■medical part of the management could be vastly improved. 
Instead of bleeding and drastic purgatives, which, as the late Dr. Brig- 
ham, of the Utica Asylum, testified, only serve to fasten the insanity upon 
the patient, he should be put upon a bland and simple diet, and a plan 
of derivative and soothing bathing. In all the appliances of water, es- 
pecial pains must be taken to keep the feet warm, the head cool, and 
to avoid all sudden shocks or strong impressions which would produce 
cerebral excitement. The tepid, shallow, hip, and foot-baths are the 
leading processes. When the patient is manageable, the wet-sheet 
pack, followed by the dripping-sheet, is appropriate ; but when these 
or any other general cold bath is employed, care must be taken to have 
the feet warm ; if they are in the least inclined to coldness, they should 
be put in warm water both before and after the bath. 

In our public institutions, insane persons are allowed flesh-meat, cof- 
fee, tea, condiments, and sometimes ardent spirits and tobacco — all of 
which is clearly wrong. 

Ungovernable Passion. — This affection, in which the judgment 
is overpowered by some predominant or ruling passion, accompanied 
with a marked change of the features and countenance, is seen under 
the forms of excited, -depressed, and fitful or eccentric passion. The 
divisions of the first are innumerable, as ungovernable joy, self-love or 
self-conceit, pride, ambition, anger, jealousy, etc., all of which are 
marked by a lively, quick, daring eye, and a flushed, tumid face. In 
the second variety the patient is anxious, pensive, inclines to solitude, 
and his countenance is pale and furrowed ; the ruling passion is mani- 
fested in ungovernable love, avarice, anxiety, longing, heartache, des- 
jiair, etc. The third variety is commonly called hair-brained passion, 
and is characterized by wayward and unmeaning passion, indiscriminate 
acts of violence, and a hurried and tumultuous manner ; it is usually the 
result of an ill-directed education. 

Special Causes. — All the causes of insanity may be among the pre- 
disposing or exciting causes of the species of mental pravity under con- 
sideration ; to which may be added debauchery, gambling, ingratitude, 



276 PATHOLOGY AND THERAPEUTICS. 

domestic trouble, loss of friends, crushed hopes, love-sickness, home- 
sickness, impending calamities, successive misfortunes, social disgrace, 
incurable secret diseases, bodily imperfection or deformity, contumely, 
imprisonment, banishment, remorse, etc. 

Treatment. — To all the remedial measures named as applicable to 
insanity, should beadded as far as practicable, recreation, occupation, and 
society. Probably nothing is more reforming to the mind or renovating 
to the body, in all forms of the malady before us, than regular, steady 
employment in some useful calling. 

Hallucination — Illusion- — Alusia. — In this affection the imag- 
ination overpowers the judgment. It embraces two varieties, one of 
which is called sentimentalism, or mental extravagance ; and the other 
is termed hypochondriacism, or low spirits. The former is character- 
ized by romantic or fantastic ideas of real life, ardent fancy, excited 
and pleasurable feelings, and animated countenance ; it embraces those 
forms of mental illusion, called heroic or chivalrous, facetious, ecstatic, 
and fanatic; in other words, romantic gallantry, crack-brained ivit, 
false inspiration, and fanaticism. The hypochondriac variety is distin- 
guished by gloomy ideas of real life, dejected spirits, anxiety, indispo- 
sition to exercise, an oblique and scowling eye, sad and sullen counte- 
nance, with a languid pulse, and prominent dyspeptic symptoms; it 
comprehends the mental states known as vapors, iveariness of life, and 
misanthropy, or spleen. 

Symptoms. — Morbid sentimentalism manifests every conceivable 
form of extravagant mis-judgment, as uncalled-for acts of gallantry, 
rampant and unrestrainable jesting, ecstasy, visions, belief in appari- 
tions, or in some preternatural endowment, etc. 

Hypochondriacism perceives a thousand evils and accidents which 
have no existence, and imagines the most whimsical and groundless 
causes of disquiet, as personal danger, poverty, frogs or geese or other 
animals in the stomach; all sorts of diseases; one perceives himself 
transformed into a giant ; another into a dwarf; one is as heavy as 
lead, and the other as light as a feather ; some suspect their friends of 
an intention to murder them, and others suspect themselves of having 
murdered their friends ; they are peevish, pleased and displeased 
with the veriest trifles, and are often unwilling either to live or die. 

Special Causes. — The first variety is often, if not generally, attributa- 
ble to a superficial and ornamental instead of a substantial and useful 
education. Novel reading is, perhaps, the most potent and most com- 
mon cause. " Perilous adventures, love-lorn catastrophes, the stories 
pf magicians, knights, enchanted castles, imprisoned damsels, nieltin" 



MENTAL DISEASES. 277 

__ . . 1 , . 

minstrelsy, tilts and tournaments, and all the magnificent imagery of 
the same kind that so peculiarly distinguished the reign of Elizabeth, 
became a very frequent source of permanent hallucination." The 
second variety is more especially connected with indigestion and dis- 
ease of the liver ; and among the common causes are alcohol, tobacco 
and intemperance and stimulation generally. 

Treatment. — In addition to the measures requisite to recover and 
maintain general bodily health, the moral or mental medication should 
consist of pleasant, cheerful, and sensible company, with a light and 
«asy, yet regular and steady business occupation, occasionally diversi- 
fied by reading sound, scientific, useful, and practical books and news- 
papers. 

Note. — Some authors name displacement of the transverse colon as 
a cause of various forms of insanity ; and the French pathologists are 
said to have frequently found this condition to exist, on post-orbit dis- 
sections, more especially in subjects who have died of the varieties of 
hallucination called weariness of life and misanthropy. I am of opinion 
some kind of structural derangement of some portion of the intestinal 
tube is a much more frequent cause of mental aberration than is gen- 
erally supposed. I have very often noticed a less degree of the same 
misaftections of mind, and also many extreme cases of those forms of 
hallucination termed fidgets, anxiety, vapors, etc., in persons suffering 
from a displacement of the lower bowel— prolapsus of the fundament. 
This is generally induced by piles ; piles are uniformly caused by cos- 
tiveness, and the ordinary dietetic habits of civilized society are exactly 
calculated to produce this diseased condition. Hence there is good 
reason to apprehend that a great proportion of those, cases of mental 
disorder coming under the present head, are owing to diseases or dis- 
placement of some portion of the digestive canal. 

But I have noticed another still more frequent cause of still severer 
forms of " a mind diseased," and I wish to give it particular prominence 
here, for the reason that it is scarcely alluded to in any medical work 
with which I am acquainted, in connection with the general subject of 
insanity. I mean displacement of the uterus. The reasons already 
assigned show us why this malady should be of frequent occurrence 
among females. They are more sedentary and in-door in their habits 
and occupations, and hence more liable to constipation, piles, prolapsed 
bowels, etc., and the general debility and relaxation of fibre often ex- 
tends to the uterus and its appendages, producing prolapsus, antever- 
sion, retroversion, and a variety of other local complaints. These 
cases require the special treatment which will be mentioned here- 
after. 

24 



278 PATHOLOGY AND THERAPEUTICS. 

Revert. — Absence of mind., mental abstraction, and brown study, 
are the usual forms iu which the misafifection of mind, termed re very, 
is exhibited. They are sometimes induced by bodily infirmity, but are 
more frequently the acquired habits, resulting from a loose, irregular, 
and superficial education — an education in which the mind is stuffed 
with words instead of being taught to think and form ideas for itself. 
This, combined with corporeal inactivity or indolence, is the principal 
reason why so many college-bred sons of distinguished men, after re- 
ceiving the highest finish of a formal education, and being "put 
through" a learned profession — law, physic, or divinity — in the offices 
of the most eminent professors, turn out wordy blockheads or profes- 
sional automatons, instead of thinking men and intelligeit citizens. 
These remarks apply mainly to the first variety of revery. 

It should be remarked, however, that some overwhelming passion, and 
intense study, especially upon the principles of mathematics and other 
abstruse subjects, are not unfrequently causes of mental abstraction, 
while these causes, coupled with the pursuit of some object of ambi- 
tion or emulation, in which the mind is kept for some time in a state 
of distraction between hope and fear, frequently induce the variety 
called brown study — the studium inane, of Darwin. 

The treatment will be readily inferred from the general principles 
of cure indicated in the preceding remarks. 

Sleep-Disturbance. — Sleeji-walking, somnambulism, and sleep- 
talking are terms which denote the forms, and sufficiently express the 
nature of the chief varieties of mental disorder connected with sleep. 
There' is in all cases an imperfect and disquiet rest, in which some of 
the mental powers are but partially asleep. The usual, and perhaps 
only causes, are an irritated or overloaded stomach, and an overexcited 
brain. Profound or natural sleep is never accompanied with walking, 
talking, or even dreaming ; hence all the phenomena resulting from 
disturbed sleep are so many symptoms of abnormal bodily or mental 
irritation. Worms in the alimentary canal, and diseases of the brain, 
are peculiarly distinguished by somnambulic manifestations. In some 
cases of somnambulism, which have been clearly traced to morbid, di- 
gestive, or eerebral excitement, and cured by appropriate remedies; 
the mental powers have been wrought up to high intensity of power, 
and have solved problems too difficult for the waking state ; and per- 
sons in such conditions have even been known to exercise clairvoyant 
powers, as in reading with the eyes shut and closely bandaged, hear- 
ing and conversing coherently while entirely unconscious, etc., while 
(he voluntary muscles unai.'ed by thr external senses, have performed 



MENTAL DISEASES. 279 

various feats of locomotion, as climbing, walking securely in the most 
dangerous places, etc., which could scarcely have been accomplished 
unless the " interior sense" had predominated over the special senses. 

Our success in medicating these affections will depend entirely on 
our skill in tracing each individual case of disturbed sleep to its particu- 
lar cause or causes, and applying our remedial measures according to 
the principles already explained. 

Fatuity. — The definition of this affection by Dr. Good, "defect or 
hebetude of the understanding," is rather too diffuse ; for some people 
are considerably prone to regard all others as in some way or other de- 
fective or foolish in judgment, who happen to feel, think, or act other- 
wise than according to their own standard of a sound understanding. 

That form of mental hebetude which is known as imbecility, is 
divided by authors into various forms, the chief of which are stupidity, 
forgetfulness, credulity, and feebleness ; while irrationality or witless- 
ness comprehends those manifestations of defective reasoning faculties 
we call folly or silliness, dotage or superannuation, and idiotism. Of 
course we must all humbly and modestly confess to some degree of 
some one or more of these " hebetudes ;" but it is only when they 
are found to form a very prominent feature of a very small minority, 
that we are to name them as leaves or branches of the great arbor 
morborum. 

Stupidity may arise from ignorance, from gross food or gluttony, 
from idleness, from intoxicating drink, from tobacco, etc. A celebra- 
ted author remarks, "Idleness in conjunction with wine and fermented 
liquors, has a proverbial power in besotting the understanding." For- 
getfulness affords many curious examples of oblivious reminiscence. 
Some forget the place or street they live in ; others cannot always pro- 
nounce then- own name at the post-office ; and instances are recorded 
ki which individuals have forgotten their mother tongue, and been 
obliged to re-learn the language from the alphabet. Credulity may re- 
sult from misdirection or original malformation ; and it exhibits all de- 
grees of imbecility, from a trifling gullibility to a disposition to take hold 
of subjects with a fervency of faith proportioned to their intrinsic ab- 
surdity. Silliness is sometimes a natural infirmity, and frequently the 
fruit of bad company and low associates in early life. Dotage is usual- 
ly considered as a mere consequence of old age, but is generally hast- 
ened on and aggravated by riotous living or excessive labor, or the hab- 
itual indulgence of violent passions. Idiofism generally results from 
defective organization, or a want of that portion of the brain which man- 
ifests the reflective faculties It may, however, be induced bv a va- 



280 



PATHOLOGY AND THERAPEUTICS. 



riety of accidental circumstances or voluntary habits, as habitual drunk- 
enness, excessive indulgence in enervating pleasures, onanism, or self- 
pollution, violent and protracted emotions of mind, external injury of 
the brain, loss of blood, etc. It has been produced by the excessive 
use of the lancet in females after delivery, in brain diseases, and in va- 
rious forms of insanity. 

Treatment. — So far as moral treatment can be of any avail, the prin- 
ciples which should regulate it have already been indicated. In rela- 
tion to the medical, much may be done to alleviate or cure those cases 
not depending on congenital or organic causes. In general terms, the 
treatment should be rather of the rousing, stirring, animating kind; as 
the dripping-sheet, douche, shower, plunge, spray, or fountain, cata- 
ract-baths, etc., combined with active out-door exercise, or regular oc- 
cupation. The diet should always be simple, bland, rather abstemi- 
ous, and strictly vegetable. An irrational mind, or one predisposed by 
organization, accident, or bad habits, to imbecility in any form, should 
avoid flesh-meat as if it were a very bohon upas. 



CHAPTER XVII. 

DISEASES OF THE VOCAL AVENUES. 

All the diseases which make up the present chapter, have, as their 
most prominent symptom, some misaffectiori of the voice or speech, 
although some of them differ very greatly in every other particular. 
They may be thus grouped : 



Chronic 
Catarrh 

Polypus 
Rhonclms 



Acute, 

Chronic, 

Ozaena. 



I Elingual, 



Speechlessness J Atonic, 

( Deaf-Dumbness. 
Compressible, ( Whispering, 

Cartilaginous. Dissonant Voice -j Immelodious, 
(Of Puberty. 

Snoring, ., C Stammering, 

Dissonant Speech < ,- 



Wheezing. ■ - "i— ■ ^ Misenunciation. 

Catarrh— CciRYZA.--When this affin tion is confined to that, part 



DISEASES OF THE VOCAL AVENUES. 281 

of the mucous membrane which lines the nasal cavities, it is called 
cold in the head ; and when the inflammation fixes permanently upon 
the same membrane in the cavities of the frontal bones, it is called ca- 
tarrh in the head. 

Symptoms. — In the acute form there is a defluxion of acrid, pellucid, 
mucous, or ropy matter from the nostrils, with a sense of irritation, and 
some degree of general fever. In the chronic variety the discharge is 
limpid, without acrimony or irritation, and unattended with febrile dis- 
turbance. The third variety, which is produced by an ozcena, or na- 
sal ulcer, is denoted by an offensive, purulent, or ichorous defluxion; it 
is often connected with caries of the spongy bones. 

Special Causes. — Sudden exposures to cold and damp, hot drinks, ir- 
ritant dust or vapors, snuff, smelling salts, strong aromatics, mercurial 
salivation, often induce this disease. Some authors give us a senile 
variety, owing to " the natural paresis of old age ;" but I hold that any 
local palsy before death is entirely unnatural. 

Treatment. — The acute form requires a few packs to reduce the 
general feverishness, which, if the diet is rigidly abstemious, and the 
patient kept in a moderately warm room of uniform temperature, will 
effect a cure in a very few days. The chronic variety — as also does 
the nasal ulcer — requires a persevering employment of derivative as 
well as local treatment. The pack occasionally, frequently sniffing cold 
water up the nostrils, the hip-bath, and one or two foot-baths daily, 
with as much exercise in the open air — avoiding, however, chilling and 
damp winds — as the patient can comfortably bear, comprise the reme- 
dial course. 

Polypus. — Polypus tumors in the nostrils are of two kinds; the 
soft, or compressible, and the hard, or cartilaginous. Both are proba- 
bly morbid growths of the mucous membrane, although the latter va- 
riety is generally connected with caries of the ethmoid or inferior tur- 
binated bones. 

Symptoms. — Nasal polypi present the appearance of fleshy, elonga- 
ted excrescences, attached by a slender neck to some part of the Schnei- 
derian membrane, extending in different directions, and affecting the 
speech by obstructing the nasal cavities. The soft kind is unattended 
with pain; its color is a pale red, having some resemblance to a com- 
mon oyster ; and it generally shrivels in dry and enlarges in wet 
weather. The hard polypus is firm, of a highly red or dark color, 
progresses gradually without alternate diminution and enlargement, 
and causes pain, with a very disagreeable sensation in the nostril and 
forehead, on coughing, sneezing, blowing the nose, etc. 



282 PATHOLOGY AND THERAPEUTICS. 



Treatment. — In the early stage frequent sniffing of the coldest wa- 
ter will often arrest, the tumor. "When it becomes troublesome from 
bulk, extirpation is necessary. 

The soft kind may be removed with the ligature or forceps ; the lat- 
ter is generally the most convenient method. The hard polypus can- 
not always be meddled with without endangering the life of the pa- 
tient. When attached to or connected with the spongy bones, these 
may be removed by a skillfiL surgeon. 

Rhonciius — Rattling in the Throat. — Snoring wad. wheezing, 
which are the chief varieties of this affection, are symptomatic of other 
diseases, as apoplexy and asthma, or of gross feeding, a plethoric habit, 
corpulency or obesity, or of an obstructed skin, by which the lungs are 
oppressed with vicarious duty, or of atony or debility of the abdom- 
inal muscles, which are important agents in the respiratory movements. 
The cure will be found in a restoration of that equilibrium in the bulk 
and action of the bodily organs and functions which is correctly termed 
health. Dr. Good recommends "taking off the obesity," in fat per- 
sons, " by repeated venesections, active purgatives, vigorous exercise, 
and a low diet." I will guaranty a perfect cure in every case of obe- 
sity on earth, by proper exercise and diet, sans all the bleedings and the 
purgatives. 

Speechlessness — Aphonia — Dumbness. — Inability of speech may 
result from destitution of tongue — and this may be congenital or accident- 
al — constituting the clingual variety ; or from paralysis of the nerves of the 
tongue or glottis, in consequence of some violent injury or shock, form- 
ing the atonic variety ; or from congenital deafness, or deafness ac- 
quired in early life, making the variety called deaf-dumbness. 

Special Causes. — When the inability is not' organic, its most fre- 
quent causes are severe and protracted colds; violent shocks, as of 
lightning or electricity ; vehement emotions, as of terror, anger, fright; 
narcotics ; mephitic exhalations ; poisoning from eating mushrooms, 
and sometimes shell-fish ; metallic vapors ; mercurial medicines, etc. 
There are also many cases of partial or complete Joss of voice, the 
cause of which is almost always overlooked or unthought of by the at- 
tending physician : I mean cases of weak voice resulting from mere debil- 
ity of the muscles of the loins and abdomen. In these cases there may be a 
moderate degree of general health, with an extreme relaxation or ri- 
gidity of these muscles, so that the balance of action between them, the 
diaphragm, and the laryngeal muscles, is lost ; the diaphragm descend- 
ing when it should ascend, and vice ve-sa. 



DISEASES OF THE VOCAL AVENUES. 283 

Treatment. — We have no special remedial resources in tho majority 
of cases which depend on incurable malformations or structural le- 
sions ; nor can we in the majority of cases dependent on functional 
derangement, do more than attend carefully to ihe general health, 
trusting nature for the local medication. In that form, however, de- 
pendent on muscular debility, we can invigorate the affected muscles by 
the wet cotapress, frequent hip-baths, various manipulations, as knead- 
ing, pounding, thumping, and a variety of exercises which call the 
weakened 'muscles into vigorous play, as dancing, jumping, riding a 
hard-trotting-horse, and vocal gymnastics, as reading, speaking, and de- 
claiming by the elementary sounds of the letters or words, etc. 

Dissonant Voice. — The chief depravations of voice have been 
ranked under the heads of ivliispering, in which the voice is weak and 
scarcely audible ; immelodious, when it is habitually rough, nasal, 
squeaking, whizzing, guttural, or palatine ; and the irregularly alter- 
nating harsh and shrill voice which is peculiar to the period of puberty. 

Special Causes. — The last named variety can hardly be regarded as 
a disease, save when complicated with some accidental abnormity. 
The other varieties are caused by most of the circumstances which 
produce the atonic loss of voice, to which may be added over-exerting 
the vocal apparatus, as in loud speaking or singing, or in straining the 
voice while the bodily attitude is crooked or distorted, or when the 
abdominal muscles are so weakened that the main effort at expulsion is 
thrown upon the muscles of the throat, chest, and diaphragm. In- 
deed, a misuse of the respiratory muscles, or in other words, a vicious 
habit of exercising the voice in early life, which has its origin in bad 
training or bad health, is the most common cause of unharmonious, un- 
musical, and unpleasant voices in after life. 

Treatment. — The special management in all forms of voice wherein 
there is no " concord of sweet sounds," consists, in addition to such 
appliances as particular complications may demand, in a regular system 
of voice-training or vocal gymnastics. Ordinary ingenuity will suggest 
a thousand variations of the general plan to suit individual cases; but 
this .general plan is, 1. An erect bodily position ; 2. Opening the 
mouth freely and fearlessly in every attempt to read or speak ; 3. 
Reading and speaking slowly, and pronouncing every syllable distinctly, 
and even giving every letter its full and appropriate sound ; 4. Pro- 
nouncing the different elementary vowel and consonant sounds of our 
language, at first slowly, and then as rapidly as possible, taking care to 
have every sound distinctly enunciated ; 5. Hallooing with a full pro- 
longed sound, as by the word over; 6. Laughing by pronounc- 



284 PATHOLOGY AND THERAPEUTICS. 

ing hah-hah-hah as rapidly as possible, observing that the abdominal 
muscles contract — that is, spring out, as it were — at every enunciation ; 
•*!. Declaiming on the sea shore in the face of a strong wind, with peb- 
bles in the mouth, a la Demosthenes, etc. 

Dissonant Speech. — Stammering has been called a sort of St. 
Vitus's dance of the vocal organs. Its principal varieties are called 
hesitating, in which there is an involuntary and tremulous retardation 
in the articulation of peculiar syllables ; and stuttering, which is an in- 
voluntary re-pronunciation of some syllables or words, alternating with 
a hurried and convulsive pronunciation of those which follow. 

Misenunciation is that form of imperfect speech in which the 
sounds are articulated freely, but inaccurately pronounced ; the princi- 
pal varieties of this affection are vicious or incorrect pronunciation of 
the letters r and I ; substitution of soft for harsher letters ; multiplica- 
tion or omission of labials, or exchanging them for other letters ; mis- 
employment of dentals, and mispronunciation of gutturals. 

All of these errors and imperfections of voice are sometimes the 
result of organic malcouformation ; occasionally, as in the case of stam- 
mering, of a constitutional irritability of some of the muscles concerned 
in articulation ; more frequently of a want of correct education ; and 
still oftener of a careless or depraved habit ; and even in some cases of 
an exceedingly silly affectation. Many stammerers who talk with 
great difficulty, read with great facility, and all of them stammer most 
when they undertake to speak most deliberately, and least when their 
attention is so engrossed with the subject that they think nothing about 
picking out single words, or arranging sentences with a view of obviat- 
ing the infirmity of speech. 

Treatment. — All that has been said in relation to the vocal treatment 
of the preceding disease, applies with equal force to this. The stam- 
merer cannot weH be too slow and deliberate in his voice exercises, 
nor should he attempt much conversation while under the remedial 
discipline, and he must exercise also the mental qualities of firmness 
and perseverance. Every expedient which he can devise to expand 
the lungs and augment their retentive capacity, will facilitate his. im- 
provement; as, for example, deep, full, and prolonged inspirations and 
expirations, during which he may to advantage count one — two — 
three — four, etc., taking pains to open wide the mouth, and "speak 
loud and plain" each monosyllable he attempts to utter. The various 
forms of misenunciation, besides the vocal exercises herein intimated, 
could with propriety be referred to a judicious course of lectures on 
elocution, nor would the lessor.8 of the singing master be without value. 



DISEASES OF THE SEXUAL FUNCTION. 286 



CHAPTER XVIII. 

DISEASES OF THE SEXUAL FUNCTION. 

The integrity of the function whose morbid affections we are about 
to consider, in its importance to the progressive improvement and well- 
being of the human race, cannot be over-estimated; yet, unfortunately, 
with regard to several diseases comprised in the present chapter, we have 
to regret, as in the case of several preceding maladies, that they are 
alarmingly on the increase. This is especially the fact in regard to 
those female diseases known as mismenstruation" and prolapsus — 
diseases of rare occurrence in the days of our grandmothers, and 
then scarcely known, except in the married relation ; but now pre- 
valent among all classes and all ages of females above mere infancy. 
These complaints are attributable to four general classes of causes ; 
sedentary habits, concentrated and stimulating food, enervating drinks, 
and unphysiological dress ; and as the refinements, and luxuries, and 
bad fashions of society increase, these natural and necessary conse- 
quences must extend correspondingly. 

It is a painful reflection, too, on the popular medical system of the 
day, that its professors, who claim to be the conservators of the public 
health, content themselves with dosing and drugging, bleeding and 
poisoning, and talking technicalities to this class of invalids, instead of 
teaching them how to live healthfully. Soundness and purity in the 
reproductive organism are indispensable to a perfect and vigorous or- 
ganization in the offspring of sexual intercourse; and if mothers and 
daughters could be imbued with the right moral principles and physio- 
logical truths, there would soon be an end to these artificially produced, 
but not the less afflictive and lamentable disorders, which are presented 
in the following tabular arrangement : 

Obstructed Menstruation — Amenorrhcea, 

Laborious Menstruation — Dysmenorrhea, 

Excessive Menstruation — Hemorrhagic,- 
Mismenstruation < , r . . •.«• * .-• 

1 Vicarious Menstruation, 

Irregular Cessation of the Menses, 

, Chlorosis — Green Sickness, 

Leucorrhen. Spermatorrhoea. 



286 PATHOLOGY AND THERAPEUTICS. 

I Syphilis, _ ,. ... . . 

- r , _ . \ „ i Inordinate S Satyriasis, 

Venereal Diseases 1 Gonorrhoea, W T , 

J „. Lust t Nymphomania. 

I" Prolapsus, 
1 Anteversion, 
Genital Displacement \ Retroversion, 
j Inversion, 
( Excrescence. 

Mismenstruation. — The catamenial secretion may be obstructed 
in its discharge, laborious and painful at the usual period, excessive in 
quantity, vicarious in its locality, irregular in its final cessation, or at- 
tended with general derangement of health at the period of its first ap- 
pearance, which several circumstances constitute the several species of 
the disease before us. 

Symptoms. — Obstructed menstruation — the amenorrhea of authors — ■ 
is distinguished into retention when the menstrual flux is obstructed at 
the period of its accession ; and suppression, when the obstruction occurs 
regularly at the usual periods of recurrence. The former variety is char- 
acterized by an oedematous swelling of the feet and ankles at night, and a 
swelling of the eyes and face in the morning ; the latter is attended 
with headache, difficult breathing, and palpitation. Both varieties are 
attended with general languor and many dyspeptic symptoms,- particu- 
larly a capricious appetite, and not unfrequently a longing for innutrient 
and injurious substances, as clay, slate-stone, charcoal, etc. In many 
cases there is a harassing cough, with symptoms of a general decline. 

In laborious or painful menstruation — dysmenorrhea — the flux is ac- 
companied with great and sometimes excruciating pain, not unlike the 
bearing-down pain of labor, generally attended with some degree of ac- 
tual hemorrhage, and frequently with an expulsion of fragments of a 
membranous concretion, like that of croup or tubular diarrhoea. In 
some instances this membranous concretion is thrown oft* from the en- 
tire surface of the uterus at once, in the shape of a small bag filled with 
a fluid which has been mistaken for an early abortion. 

In excessive menstruation the catamenial secretion is superfluous in 
quantity, and attended with an actual hemorrhage from the menstrual 
vessels. The hemorrhage is known by the fact that the fluid discharg- 
ed is coagulable, which is not the case with the pure catamenial flux. 
It exhibits two subvarieties, in one of which the discharge is excessive, 
from too frequent recurrence, and in the other from too copious a flow 
at the proper menstrual period. Tho ordinary flux may be from four 



DISEASES OF THE SEXUAL FUNCTION. 287 

to six ounces, but it is subject to much diversity, sind can only be re- 
garded as morbidly in excess when accompanied with marked symp- 
toms offjeiieral debility, as paleness, cold extremities, cedematous feet, 
fatigue on slight exercise, etc. 

Vicarious menstruation is characterized by a transfer of the catame- 
nial secretion to a more distant part or organ. The eyes, nostrils, ears, 
sockets of the teeth, nipples, stomach, lungs, rectum, bladder, and 
abraded or ulcerated surfaces, have been the seat of the transferred 
flux. 

The irregular cessation of the menses, at the term of its natural ces- 
sation — usually called the turn of life — which in this climate is, on the 
average, at about the forty-fifth year, is accompanied with symptoms 
of spurious pregnancy, dropsy, or glandular tumors ; the menstrual dis- 
charge is irregular ; sometimes profuse with long intervals ; and at 
others trifling in quantity, but returning every ten or twelve days, and 
ofteu succeeded by leuccohcea. 

Chlorosis, or green-sickness, though elevated to the rank of a gen- 
eric term by some authors, is merely a condition of imperfect or defi- 
cient menstruation, occurring about the age of puberty, and complica- 
ted with so great general debility that the sexual power or propensity 
is partially or completely lost. The name is derived from the pale, 
livid, and greenish cast of the skin, which all chlorotic patients mani- 
fest more or less. 

Special Causes. — In addition to the general causes already intima- 
ted, mismenstruation maybe induced by repeated colds, especially from 
an exposure of the feet while the rest of the body is well clad, pro- 
tracted anxiety, grief or fear, local injury, masturbation, excessive ve- 
nereal indulgence, repeated miscarriages, etc. Retention of the men- 
ses is sometimes owing to an imperforate hymen, requiring for its cure 
a transverse section of the membranous obstruction. 

Treatment. — Fortunately almost every form, state, and stage of mis- 
menstruation is curable, by the thorough application of our whole 
system. The majority of cases, however, require several months', 
and many of thein two or three years' treatment to complete the cure. 
But fortunately, again, those cases which require a long treatment, can 
be managed mostly nt home, and with very little expense or neglect of 
ordinary duties or labors. The general plan applicable to all forms of 
the disease except excessive menstruation is, a morning full-bath, as 
the plunge, dripping-sheet, or towel-wash, two or three hip-baths daily, 
one or two foot-baths, the abdominal bandage, frequent and varied out- 
door exercise, and a plain, solid, rather dry, and unstimulating dietary. 
The water should in all cases be as cold, yet^uo colder, than is follower! 



288 PATHOLOGY AND THERAPEUTICS. 



by quick reaction and a comfortable glow ; and, as a general rule, short 
baths, frequently repeated, are more efficacious than long ones with 
greater intervals. Hip and foot-baths should always be preceded and 
succeeded by active yet not exhausting exercise, and the walking foot- 
bath, when practicable, is always to be preferred. A great variety of 
exercises can be advantageously employed, as walking, riding, jump- 
ing the rope, dancing, shuttle-cock, graces, etc. And those who can 
find the same recreation and entertainment in light work, as sweep- 
ing, dusting, spinning, washing dishes, picking berries, milking the cows, 
etc., will find exactly the same remedial effects as from amusing and 
agreeable plays. 

When the body is full, sanguine, and plethoric, the wet-sheet pack 
should be employed daily or tri-weekly for a month or two ; and 
when the whole system is in the opposite condition, called atonic, an- 
hoemic, torpid, etc., the tepid shallow-bath, followed by active and pro- 
longed rubbing, should be substituted. In cases of excessive menstru- 
ation, the hip-baths should be colder than in either of the other varie- 
ties, generally from 55° to 45°. In the variety, irregular cessation, care 
must be taken not to disturb the circulation with any powerful shock ; 
the treatment in the main should be mild, the water generally tepid or 
but moderately cold. The exercises, too, in the last two varieties, 
should be very moderate. 

Vaginal injections are useful in all cases attended with considerable 
relaxation, hemorrhage, or leuorrhoea; while in all other varieties, the 
horizontal douche or spray, applied to the hips, abdomen, and loins, is 
a valuable auxiliary. 

When the catamenial periods are attended with much pain, as in 
dysmenorrhcea, warm applications must be employed until relief is ob- 
tained, after which the regular treatment may be resumed. These 
stiould consist of the warm foot-bath, warm sitz-bath, hot fomentations 
to the abdomen, the full warm-bath or even hot-bath, followed by the 
dry pack, according 'to the severity of the pain. In some cases the 
pain is agonizing for one, two, or three days, and the only endurable 
condition for the patient is to remain dry-packed, or closely covered up 
m bed, so as to keep the body warm and perspirable until the secretion 
takes place. Drinking warm water very freely often proves relaxant 
and sedative in these cases. 

The propriety of suspending a part or the whole of the treatment 
during the menstrual period, not only in the complaint before us, but 
in all cases, is somewhat unsettled in the code of hydrotherapia. Some 
practitioners, at least in all ordinary cases, pay no regard to the monthly 
flux, while others suspend all active or very cold treatment. It is true 



DISEASES OP THE SEXUAL FUNCTION. 289 

the menses are frequently partially suppressed or wholly suspended 
for several months by the former practice, yet it seldom happens that 
any permanent injury comes from it. My own opinion, derived from 
considerable attention to the practical point under consideration is, that 
patients who are not much reduced in flesh, blood, or temperature, 
can take full treatment through the catamenial disturbance, not only 
without injury, but often with benefit ; but that those who are emaciated, 
pale, and cold, with torpid livers and clogged up skins, and a tendency 
to headache or " rush of blood to the head," will be better off to take 
no treatment, save a tepid wash-down daily, and such local soothing 
appliances as particular exigencies call for, from the first decided indi- 
cations of the menstrual effort, until it has nearly or quite subsided. 
There are few diseases in which regimen should have a greater 
prominence among the curative measures. With respect to water- 
driuking, I have always recommended those of full habit and well ex- 
panded lungs to drink rather freely — four, six, or eight tumblers daily — 
and the thin and feeble to take two or three tumblers in the fore part 
of the day, and at other times only according to actual thirst. The 
diet cannot well be too strict, and as constipation is almost always 
connected with mismenstruatiou, it should have especial reference to 
this circumstance. i 

Brown bread, unfermented bread or cakes, cracked wheat or rye meal 
mush, with a moderate allowance of the best vegetables and good 
fruits, constitute the best dietetic plan. Very little animal food, if any, 
should be taken, and even eggs, butter, and milk, had better be avoided. 

Leucorrhea. — This disease is indiscriminately called Jiuor albus and 
whites in medical books. It affects more or tess nearly all females who 
are the subjects of mismenstruation, and sometimes exists antecedently, 
and at others subsequently to the menstrual period of life. It is most 
frequently the immediate result of local irritation. It has been for a 
long time, and is yet a question among medical authors, whether this 
disease is ever infectious, and communicable to the male urethra by the 
act of copulation. Two years ago, a "professor of diseases of women 
and children," in one of our city colleges, and an ex-professor of the 
same branch in another orthodox school, were called upon in a court 
of justice, to give testimony on this very point. The latter professor 
testified that he had actually known such infection to result from leu- 
corrhcea, in his own emphatic language, " again, and again, and again ;" 
while the former declared that he did not believe it was possible ! Both 
medical gentlemen, of course, swore conscientiously. It is a general 
law in pathology — so general that I believe there are no exception.' ^- 
II— 25 



290 PATHOLOGY AND THERAPEUTICS. 

that all abnormal secretions are bland or acrid, precisely according to 
the less or greater grossness or impurity, or inflammatory condition of 
the general system ; all morbid discharges from mucous surfaces may 
become, as is often seen in the case of catarrh or coryua, so acrimo- 
nious as to excoriate the surface wherever they come in contact with 
it; and the mucous surface of the vagina may readily, under circum- 
stances of extreme irritation and high inflammatory excitement, se- 
crete an icherous or infectious matter, which will produce in the male 
urethra a running analogous to gonorrhoea or gleet, though, of course, 
not as violent nor inflammatory as in true gonorrhoea, nor infectious like 
it. I have known cases of this kind under such circumstances as pre- 
cluded all idea of impropriety on the part of the wife, by whom the 
husband became diseased. These facts ought to be well understood by 
the practitioner, so that the woman, though she may not be an exam- 
ple of strict personal cleanliness, may be exempted from the charge of 
moral impurity. 

Symptoms. — The discharge is usually of a yellowish-white color, 
verging to green; but sometimes it is brownish, or slightly red, vary- 
ing in consistence from a thin limpid fluid, to a thick, tenacious, ropy 
mucus. It is usually accompanied with weakness or pain in the back, 
and some degree of " spinal irritation ;" when of long standing, it is 
attended with a sense of heat, and itching or smarting ; and in still 
more advanced stages, the discharge is highly acrid and offensive, often 
excoriating the whole surface of the vagina. 

In the form called labor, the discharge is slimy and tinged with show 
of blood, and is only regarded as morbid when excessive. The whites of 
advanced life generally appear soon after the cessation of the menses ; 
the dischaigu is thin, acrid, fetid, and excoriating, and is sometimes 
combined with incipient cancer or polypus. 

Special Cuuses. — The same general range of morbid influences 
which predispose to, or excite mismenstruation. contribute to the pro- 
duction of leucorrhcea, to which may be added mechanical injuries and 
irritations, as pessaries, repelled eruptions, voluptuous excitement, and 
uncleanliness. 

Treatment. — Dr. Good remarks, in relation to the drug-treatment of 
leucorrhcea, "The general remedies which have been had recourse to 
are almost innumerable;" a sufficient acknowledgment that they have 
generally proved either useless or injurious. The general hydropathic 
plan of medication is the same as for mismenstruation. The local 
treatment requires more especial attention. Hip-baths and vagina] in- 
jections are always among the leading measures, and the temperature 
of the water for either purpose must be regulated by the condition of 



DISEASES OF THE SEXUAL FUNCTION. 291 

the patient. In some cases the diseased surface is so irritable that 
quite warm water proves the most available sedative. It is always safe 
and generally necessary to commence these baths with water at 80" or 
90°, and gradually reduce the temperature to 60° or 50°. The vaginal 
syringe in severe cases should be employed two, three, or four times a 
day. Whenever the discharge is excessive and blood-colored, indica- 
tive of actual hemorrhage, very cold water should be thrown up the 
vagina, and cola wet cloths laid over the abdomen. 

Spermorrhcea. — Seminal misemission, or an involuntary flux of the 
seminal fluid without copulation, is often the result of libidinous ideas, 
especially if to this cause is added the irritation of a gross or highly 
animal diet, or the still more inflaming and exciting influence of wine, 
coffee, etc. Not unfrequently the gross and debasing habit of self-pol- 
lution, induces such a degree of nervous exhaustion and morbid irrita- 
bility, that the emission takes place on the slightest libidinous excite- 
ment ; and sometimes a thin, degenerate, muco-seminal secretion oc- 
curs unconsciously during a dreamy or even a profound sleep. 

Treatment. — When the general health is fair, and the patient has 
not been guilty of a concupiscent life, one or two daily cold baths, ac- 
tive out-door exercise, or what is better, regular and laborious occupa- 
tion, and a plain vegetable and fruit diet, will speedily effect a cure. In 
constitutions worn down by previous diseases, exhausted by riotous liv- 
ing, or undermined by abused amativeness, the cure requires a strict 
and persevering observance of all the laws of hygiene, that the patient 
may out-grow rather than doctor out his ruinous ways. Unfortunate- 
ly, however, there is no class of patients more fickle, vascillating, and 
unreliable ; the mind partakes of the bodily degeneracy, and it re- 
quires a combination of rare and favorable circumstances to keep 
them from running after every foolish and whimsical impostor who ad- 
vertizes to cure them with a single bottle of bitters, which, moreover 
is " pleasant to the taste." 

These patients seldom need very active or very cold water-treat- 
ment. A daily towel-bath, one or two tepid or moderately cool hip- 
baths, and a rigidly simple and abstemious diet, afford the best chance of 
recovery. Salt, sugar, and even milk can be dispensed with to advan- 
tage. The evening meal should always be light and as dry as possible, 
and the patient should avoid sleeping on the back, the preferable posi- 
tion in bed being a gentle inclination to one side. 

Venereal Diseases. — The affections yf the genital organs which 
result from impure sexual intercourse are among the most loathsome 



292 PATHOLOGY AND THERAPEUTICS. 

in appearance and the most deplorable in their consequences that af- 
flict degraded and erring mortals. 

Symptoms. — Venereal affections appear in two distinct forms, syphi- 
lis, or pox, and gonorrhoea, or clapp. The first is a constitutional 'dis- 
ease, or, rather, may become so ; the second is always a local disease, 
never extending beyond the genital organs or glands of the groin. Both 
diseases, however, may coexist in the same individual, and be commu- 
nicated at the same time. Gleet is simply a urethral running; and, 
though often a sequel of gonorrhoea, may exist from irritation uncon- 
nected with venereal taint, and be excited by stone in the bladder, leu- 
corrhoea, and various other causes. These distinctions are important to 
keep in mind, for thousands have their constitutions ruined by a long 
mercurial course for gonorrhoea, on the mistaken notion that the dis- 
ease was in the blood or general system. It should be remarked, too, 
that syphilis never affects the constitution until after the formation of 
an ulcer and the absorption of its matter. 

Syphilis commences with one or several small pimples, or chancres, 
on some part of the genitals, which gradually fester, and finally termi- 
nate in spreading or deepening ulcers, filled with an exceedingly acrid 
and corroding matter. If this matter is allowed to be absorbed, the 
glands of the groin swell into hard tumors, called buboes, and often ul- 
cerate. ■ Eventually the whole body becomes contaminated with the 
virus absorbed from the chancres, and what are called constitutional or 
secondary symptoms appear, as foul ulcers in the throat and palate, 
livid and copper-colored spots on the .skin, or ulcerating scabs, inflamed 
eyes, pains, swellings, and caries of the bones, etc. 

Gonorrhoea — blenorrhosa luodes — consists in a muculent and virulent 
discharge from the urethra or vagina, attended with a burning pain in 
passing the water, and considerable, sometimes violent pain, heat, and 
swelling of the part affected ; in some instances the inflammation ex- 
tends to the glands of the groin, producing buboes. 

Special Causes. — Venereal diseases may be generated by promis- 
cuous sexual intercourse, and when produced, the peculiar virus thus 
developed is capable of propagating the same disease by contact. 

Treatment. — The ulcer or chancre should be destroyed by fire or 
caustic as soon as it makes its appearance. Aqua fortis or lunar caustic 
may be employed for this purpose. When the ulcer has already 
spread over a large surface or corroded deeply into the flesh, its virus 
may be destroyed by repeated applications of a strong solution of the 
caustic or diluted aqua fortis — one part to six of water. In all other re- 
spects both forms are to be treated as ordinary local inflammations. The 
proper temperature of the water for sitz-baths, which should be fre- 



DISEASES OF THE SEXUAL FUNCTION. 293 

quently employed, will vary greatly in different cases; but in all cases 
that temperature is to be preferred which produces the most sedative 
or soothing effect. In some cases the morbid irritability is so extreme 
that cold water aggravates, while warm or very warm quiets the irri- 
tation, and relieves the pain and irritation at once. 

Inordinate Lust — We need not dwell long on this affection. 
Authors have applied the term satyriasis to an ungovernable sexual 
passion in the male ; and the term nymphomania to a similar propensi- 
ty in the female. They are both produced by some local irritation, 
which may have its origin in the general mental or physiological habits 
of the individual. The most frequent combination of causes which op- 
erate to produce a state of lascivious furor is, gross, high-seasoned food, 
intoxicating drinks, indolence, and personal uucleanliness — in other 
words, inattention to bathing. 

These views of the causation of the disease, are supported by the 
fact that it is more common in advanced life, even beyond the "three 
score and ten'' period, than in youth or middle age. The cure will 
readily be found in frequent general cold baths, copious water-drink- 
ing, active exercise or occupation, warm relaxing hip-baths, and a sim- 
ple vegetable diet. 

Genital Displacements. — The true pathology or proximate con- 
dition of these affections is but little understood by the medical profes- 
sion, as is apparent from the general ill-success attending the ordinary 
treatment. The term prolapsus is used indiscriminately for all degrees 
of simple descent, or falling of the womb ; but in some books the term 
relaxation is applied when the descent is only to the middle of the 
vagina ; procidentia, when the uterus descends to the labia ; and pro- 
lapsus, when it protrudes externally. Retroversion is that form of dis- 
placement in which the fundus uteri descends toward the sacrum, the 
os uteri or mouth of the womb inclining toward the pubes. Antever- 
sion is the reverse of the preceding, the fundus falling forward and the 
os uteri inclining backward. In inversion the organ is turned inside out 
while in a state of prolapse. In some cases the upper part of the 
vagina protrudes into the lower, constituting what is called prolapsus of 
the vagina. 

Symptoms. — Prolap>sus of the uterus is attended with a heavy, dis- 
agreeable, or painful dragging-down sensation at the lower part of the 
abdomeiij aching or weakness about the small of the back, and when 
severe, great difficulty or inability in walking. At first there is in- 



294 PATIfOLC^Y' AND THERAPEUTICS. 

creased mucous secretion, which increases by degrees until it acquires 
the character of an obstinate leucorrhoea. 

When the uterus is retroverted the bowels are irregular or consti- 
pated, and from the pressure of the displaced organ on the rectum be- 
hind and the urethra in front, there is more or less difficulty experi- 
enced in expelling the contents of the bowels and bladder. In this 
situation the womb often becomes congested, inflammatory, and en- 
larged, and every attempt at walking is exceedingly painful or ex- 
hausting. In bad cases the patient can only endure a fixed, quiet, 
almost motionless position in her chair or bed. There is, too, usually, 
considerable tenderness and tension of the whole abdomen. 

Anteversion is a less frequent occurrence; it is denoted by difficulty 
in walking, sense of weight or fullness in the pelvis, with many of the 
•symptoms of prolapsus, and is attended with much less difficulty in 
evacuating the urine and feces than retroversion. 

Inversion is known by the organ hanging down externally ; it is usu- 
ally the result of violence in extracting the placenta, but may occur 
from an adhesion of the placenta, or from polypus tumors. 

In some instances the falling down of the uterus or vagina drags 
along the bladder with it, constituting what is called complicated pro- 
lapse. In this case the bladder, being deprived of the expulsory aid 
of the abdominal muscles, is incapable of evacuating its contents with- 
out artificial assistance. 

Genital excrescence consists in polypus or other tumors, issuing 
from the surface of the uterus or vagina. They are of all sizes and 
of various degrees of consistence, from the softness of sponge to the 
firmness of leather. 

Special Causes. — Although medical authors and professors of mid- 
wifery are continually talking about " relaxation of the ligaments" 
which hold the uterus in position, as the main cause of its displace- 
ment, it is quite clear that this relaxation has nothing whatever to do 
with it ; the yielding or elongation of the ligament being itself an effect 
of the displacement. The natural supports of the uterus are the 
vagina and the abdominal muscles ; if the former is greatly relaxed the 
uterus will descend, and the ligaments, being kept constantly on the 
stretch, will finally elongate more or less ; and if the abdominal mus- 
cles are greatly debilitated, they do not contract vigorously, so as to 
keep up equable and uniform compression in all the various positions 
of the body, hence the uterus is liable to fall forward or backwasd, or 
incline laterally; and when both are badly relaxed and debilitated, we find 
both conditions of displacement — falling down and tipping transversely 
across the pelvis. In corroboration of this view of the subject, I may 



DISEASES OF THE SEXUAL FUNCTION. 29& 

advert to the fact, that all the cases of uterine displacement we meet 
with in practice, with the single and rare exception of such as are 
produced by violence, occur in felnales who suffer from the very cir- 
cumstances which are most efficient in inducing muscular relaxation 
of these parts, as constipation, piles, dyspepsia, nervous debility, mis- 
menstruation, abortions or miscarriages, preternatural labors, etc. 

Treatment. — How impotent for good, and how potent for evil, are 
all the common chirurgical and drug-shop appliances for the manage- 
ment of these cases, may be inferred from the preceding explanation 
of their nature and proximate cause. Pessaries innumerable have been 
invented, trusses, braces, and supporters of all sorts and shapes have 
been contrived, and blisters, issues, and caustics, of every kind, have 
been resorted to, while many times the miserable sufferer has been 
kept confined to a fixed position in bed for six months or a year, all 
intended to aid, force, and sting the " relaxed ligaments" into contrac- 
tion, but which have, in nearly all cases, operated greatly to the disad- 
vantage of the relaxed muscles, and thereby greatly aggravated the 
difficulty. 

A rational medication will abjure all these " evidences of mechanical 
and chirurgical skill," anil regard, first of all, the general health. All 
the resources of hygiene must be discriminatingly adapted to each in- 
dividual case. No class of patieuts require a more rigidly simple and 
abstemious diet. I have had many patients confine themselves for 
weeks to brown bread, boiled potatoes, and baked apples, or some plan 
as simple, and always with the best, results. Nothing will conduce 
more to bring about a firm, energetic, contractile state of the whole 
muscular system. If a strict diet is adopted, very little water-drinking 
is necessary. The bathing part of the treatment must in general be 
moderate, for the reason that most patients can take but littlo exercise. 
A daily tepid dripping-sheet or halt-bath, with one or two tepid hip- 
baths, a foot-bath in the evening, with two or three vaginal injections 
daily, of as cold water as can be borne without disquiet, is the usual 
combination of baths which are most serviceable in these cases. To 
these I would always add occasional packs when the patient has a good 
degree of reactive power or superficial heat and circulation. As in all 
other cases, the patient should exercise according to ability ; but in 
bad displacements very little can be done in this way until the uterus 
is restored to its natural position. This must be done mechanically, 
when the ordinary external means fail. The os uteri must be found 
and elevated, or drawn backward or forward, according to the kind of 
displacement. While the uterus is in position, the abdominal muscles 
must be strengthened by active yet gentle manipulations, and the re- 



296 PATHOLOGY AND THERAPEUTICS. 

laxed fibres of the vagina constringed by injections of a small quantity 
of very cold water. The patient should commence walking, or increase 
her usual amount of exercise, as soon as the organ is replaced, and 
gradually extend the excursions or gymnastics, as the muscular strength 
improves. When the uterus is inflamed and enlarged, and the parts 
painful and tender, the replacement should not be attempted until 
these symptoms have been partially subdued by the treatment. In 
some cases an appropriate instrument is necessary to effect the replace- 
ment, and when the vagina is extreme]) relaxed, the uterus will have 
to be supported with a piece of soft sponge inclosed in a delicate cap- 
sule of India rubber, until the requisite musculai contraction can be 
induced. 

The inverted uterus should be restored as soon as possible after the 
accident which induced it, or its contraction will render the operation 
impossible. The treatment of the excrescent variety comes within 
the province of the surgeon ; and of the various operations proposed 
for its removal the ligature is the best. 



CHAPTER XIX. 

DISEASES OF THE URINARY ORGANS. 



The various forms of mismicturition, which consist in morbid secre- 
tions or discharges of urine, are : 

Destitution of Urine — Suppression. 
Retention of Urine — Ischuria. 
Painful Urination — Strangury — Dysuria. 
Saccharine Urine — Diabetis. 
Incontinence of Urine — Eneuresis. 
Unassimilated Urine — Urinary Diarrhoea. 
Erratic Urination-— Vicarious Urination. 

Gravel, 

Stone. 



Urinary Calculus •] 



Destitution of Urine. — In this affection the urine is not secretei 
by the kidneys ; there is no sensation of fullness or uneasiness in the 
bladder, nor any desire to urinate. The excrcmentitious elements of 
the renal secretion are more or less thrown off by (lie other emunc- 



DISEASES OF THE URINARY ORGANS. 297 

tories, but not sufficiently to prevent great constitutional suffering, 
evinced by general torpitude, apepleptic symptoms, etc. Most of the 
subjects of this complaint are fat, corpulent persons, considerably ad- 
vanced in life, and the disease generally proves fatal in a very few 
days. 

Treatment. — To relieve the blood as fastas possible of its urinous accu- 
mulations, the wet-sheet pack and dripping-sheet should be employed ; 
while the action of the kidneys should be excited by the alternate hot 
and cold hip and foot-baths, or better still, perhaps, the warm douche 
followed by the cold to the loins and abdomen. The bowels should 
also be moved by copious injections. 

Retention of Urine. — In this disease the urine is duly secreted, 
but its flow is interrupted by spasm, inflammation, calculi, tumor, 
stricture, abscess, concretions in the rectum, distention of the vagina, or 
debility or palsy of the bladder itself. A frequent cause is over-disten- 
tion of the bladder in consequence of holding the water too long, when 
it has been inconvenient to void it. This condition is always attended 
with pain, protuberance, and a frequent desire to urinate. 

Treatment. — In most cases a hot hip-bath, or hot fomentations to the 
abdomen, followed by a dash of cold water, will relieve ; but if they 
fail, the catheter must be promptly employed. 

Painful Urination. — Strangury, or a painful and dribbling dis- 
charge of urine, may result from several of the causes of the preceding 
malady ; but generally it is excited by acrid food, drinks, or medicines, 
particularly canfharides, or Spanish flies, and is attended with a scald- 
ing sensation. It is also occasioned by a stricture, or callous thickening 
of the lining membrane of the urethra, in which case the micturition is 
extremely troublesome and distressing, the straining often causing the 
bowels to deject their contents at the same time. 

Treatment. — These cases are generally relieved by copious water- 
drinking, and warm hip-baths ; in severe cases the full warm-bath may 
be necessary. 

Saccharine Urine. — Diabetis, termed water-flux, or urinal dropsy, 
by the authors, consists in a free or profuse discharge of urine, of a 
violet smell, and generally of a sweet taste, attended with great thirst 
and general debility. Medical writings are full of speculations as to the 
nature and proximate cause of the saccharine matter or sugar which is 
sometimes found in very large""quantities in the urine of diabetic pa- 
tients; but as they shed no light oi: the subject, they are hardly worth 



298 PATHOLOGY AND THERAPEUTICS. 

our attention and limited space. The most important fact they have . 
made us acquainted with is, that the skin is always in a condition of ex- 
treme torpitude. 

Treatment. — This disease has terminated fatally, with very few ex- 
ceptions, under allopathic treatment. Instead of dosing the kidneys or 
stomach, as has been and yet is the custom of the drug-doctors, we 
should direct our main efforts to restore the cutaneous function, which 
is, in fact, the only way to take off the excessive determination to, and 
irritation of, the kidneys. When the skin is cold, pale, and bloodless, 
the tepid dripping-sheet, followed by the dry pack so as to produce 
moderate perspiration, and the half or shallow-bath, followed by the dry 
rubbing-sheet, with thorough friction to the whole surface, are the 
leading measures of treatment. Water may always be drank to the 
extent of thirst, and the diet should be mainly farinaceous, and the arti- 
cles principally dry or solid, as wheat-meal biscuits, brown bread, roast- 
ed potatoes, Graham crackers, etc. 

Incontinence of Urine. — Eneuresis, as the present form of mor- 
bid urination is generally called, is a frequent or perpetual discharge, 
with difficulty of retaining the urine. It is variously occasioned by an 
acrid quality of the urine, local irritation, atony or debility of the 
sphincter of the bladder, and a superabundant secretion. The remote 
causes are chiefly hot drinks, diuretic drinks or medicines, intoxicating 
liquors, etc. The plan of cure is the same as for the preceding dis- 
ease, especial care being taken to avoid, correct, or remove the ex- 
citing causes. 

Un assimilated Urine. — In this affection the urine is impregnated 
or colored with various alimentary or medicinal articles which have 
been taken into and have found their way to the kidneys, and through 
the bladder, unchanged. Rhubarb, prussiate of potash, and other drugs 
pass rapidly to the kidneys without undergoing decomposition ; and 
those articles which are called diuretics are carried to the kidneys di- 
rectly without going the rounds of the circulation. In some cases of 
impaired digestion, the urine is impregnated with a matter resembling 
chyle. This affection is but an " effort of nature" to rid the body of 
extraneous ingredients ; and hence copious water-drinking, a strict diet, 
and a daily bath are all the remedial measures which seem to be indi- 
cated. 

Erratic Urine. — A vicarious discharge of urine at some foreign 
outlet is not an unfrequent occurrence. It is an evidence of the vis med- 



DISEASES OP THE URINARY ORGANS. 299 

icatrix naturce, to deterge the blood of its urinous elements when some 
obstacle prevents their expulsion at the natural emunctory, or when 
from atony or disease of the kidneys it is not secreted at all. In such 
cases a urinous fluid has been evacuated by the stomach, bowels, skin, 
salivary glands, ears, eyes, nostrils, breasts, navel, and at ulcerous sur- 
faces and fistulous openings. The medication is the same as in the 
preceding diseases. 

Urinary Calculus. — Accumulations of calculous matter in the 
urinary cavities, are either renal or vesical, as they are found in the 
kidneys or bladder. Renal calculi comprehend the various forms of 
urinary sand or gravel ; and vesical calculi constitute the various kinds 
of stone. 

The chemical elements of these concretions are urea, uric acid, lac- 
tic acid, sulphates, hydrochlorates, and phosphates of potash, soda, 
and ammonia, and various other occasicual ingredients. The most 
common form of urinary calculus is that called the Uthic or uric acid, 
consisting of urea with some free acid and ammonia. 

The oxalate of lime, called also mulberry calculus, is the next in fre- 
quency ; and the other most frequent varieties are the phosphate of 
lime and ammonia, and phosphate of magnesia calculi. They vary in 
size from line particle.3 of sand to lumps of several ounces. 

Symptoms. — Calculous matter in the kidneys is attended with a fixed 
pain in the loins, shooting downward toward the thighs, which are af- 
fected with numbness ; the pain is increased by exercise ; the urine 
often deposits a sandy sediment, which may be either of a white or 
red color ; the pain often alternates with a sense of weight. 

The passage of a large gravel or sandy particle through the ureters 
is often intensely agonizing, and accompanied with nausea, fainting, and 
generally retraction and inflammation of one of the testes. The pulse, 
however, is not affected, from which circumstance this affection may 
be distinguished from inflammation of the kidneys or bladder. 

If the calculus is stopped in the ureter, heat, thirst, and fever come 
on, and the retained urine being thrown back into the blood, soon OC' 
casions intermitting pulse, coma, convulsions, and death. 

Stone in the bladder produces a frequent desire of making water, 
with a difficulty of discharging it; there is acute pain at the extremity 
of the urethra, and on sounding the bladder the instrument meets with 
a sonorous resistance. After horseback-riding, or any hard, jolting ex- 
ercise, the urine is bloody ; in some cases it is voided by drops, and 
sometimes the stream is suddenly stopped before urination is com- 
pleted. When the stone becomes large there is a dull pain about the 



300 PATHOLOGY AND THERAPEUTICS. 

neck of the bladder, and the rectum is affected with a troublesome te 
nesmus. 

Special Causes. — Hard water, the free use of salt, alkalies, especial- 
ly the ordinary employment of saleratus ; strong acids, as vinegar, vi- 
nous and fermented liquors, and flesh-meats, are the most common and 
most efficient causes. 

The general connection of the calculous or lithic acid diathesis with 
the gouty — both being almost always manifested in the same person — 
points with unerring certainty to animal food and wine as among the 
leading causes. 

There is no doubt in my mind that the salts and magnesia with which 
nursing mothers and sucking infants are so frequently dosed " for me- 
dicinal purposes," occasion many of the cases of gravel and stone we 
meet with in young children. 

Treatment. — To alleviate the suffering, the warm hip-bath, and in 
extreme cases the full warm or hot-bath is necessary ; and if the pain is 
prolonged, the wet-sheet pack, of two or three thicknesses, will be the 
best sedative. 

The curative treatment consists in freeing the whole system from 
all extraneous ingredients as rapidly as possible, for which purpose the 
diet must be strictly vegetable ; the drink nothing but pure soft water, 
and frequent packing and rubbing wet-sheets, with such additional ap- 
pliances as the general health may demand. 

Our old-school friends have a variety of chemical tests to determine 
the acid or alkaline predominance of the calculus ; if acidity prevails, 
alkalies are administered; and if alkalies are most abundant, acids are 
the remedies. This is like putting out a fire by throwing on green or 
wet wood ; it dampens the flame for a moment, but increases the com- 
bustion in the end. These acids and alkalies are all the while filling 
the system with the very ingredients which afford the material for cal- 
culous formations. The surgical operation for stone will be considered 
hereafter. 

Note. — The success which has attended the diuretic treatment of 
calculous affections, in the hands of some physicians who have made this 
branch of the profession an exclusive business, is corroborative of the 
pathological and therapeutical views above advanced. The treatment 
of these " gravel doctors" consists mainly in the free use of vegetable 
diuretic drinks — decoctions of dandelion, milk- weed, queen of the mead- 
ow, etc. These drinks are continued for several months, and by in- 
creasing the amount of fluid which passes through the kidneys and 
bladder, assist to wash away the superfluous earthy particles. 



DISEASES OF THE SKIN. 



801 



CHAPTER XX. 



DISEASES OF THE SKIN. 



Some three hundred abnormal appearances of the skin have been de- 
scribed as distinct diseases by authors ; and I know not why a sufficient 
amount of ingenious but useless analytical skill, by elevating every pe- 
culiar mark, spot, blotch, patch, or pimple, to the rank of a specific 
malady, might not extend the list to three thousand. The follow- 
ing tabular arrangement comprehends all that are important to distin~ 
•guish, for either theoretical or practical purposes : 



Cutaneous Rashes 



Blains 



Macular Skin < 



Cutaneous Vermi- 
nation 



Rose Rash, 
Gum Rash, 
Lichenous Rash, 
Pruriginous Rash, 
.Millet Rash. 

f Water-Blebs, 
I Herpes, 
j Rhypia, 
I, Eczema. 
( Veal Skin, 

Mole, 

Freckles, 

Sunburn, 

Orange Skin, 

Piebald Skin, 

Albino Skin, 

Cyanosis. 
( Lousiness, 
J Insect Bites, 
^ Worms. 



[ Dandruff", 

Scaly Eruptions < _ ^ ?' 
I Psoriasis, 

[ Ichthyiasis. 

f Impetigo, 

Humid Scalls { „ 1 US °' 
j Ecthyma, 

[ Scabies. 

' Profuse, 
Bloody, 
Morbid Sweat J Colored, 
Scented, 

b Sandy. 

' Bristled, 
Matted, 
Extraneous, 
Forky, 
Gray, 
Baldness, 
Areated, 
Discolored, 
Sensitive. 



Morbid Hair< 



Cutaneous Rashes.— Rose Rash— roseola of authors— is an efflor- 
escence which appears in blushing patches on the cheeks, neck, or 
26 



302 PATHOLOGY AND THERAPEUTICS. 

arms, often fading and reviving ; usually appearing in the spring or au- 
tumn. Gum Rash— strophulus— -is peculiar to early infancy, and con- 
sists in an eruption of red or whitish pimples about the face, neck, and 
arms, interrupted by-irregular patches of inflammatory blush, and man- 
ifesting several sub-varieties, called red gum, tohite gum, tooth rash, 
wild-fire rash, etc. The lichenous rash is characterized by a diffuse 
eruption of red pimples, with a troublesome and sometimes ^intolerable 
sense of itching or pricking; it is subdivided into simple lichen, summer 
rash, or prickly heat, wild lichen, nettle lichen, hair lichen, clustering lich- 
en, livid lichen, according to its varying and unimportant appearances. 
Pruriginous rash is known by a diffuse eruption, with pimples of nearly 
the same color as the cuticle, itching acutely, and when abraded or 
broken by the nails, emitting a fluid that concretes into minute black 
scabs. The millet rash is distinguished by very minute, tubercular, 
distinct, milk-white, hard, and glabrous pimples, which are confined to 
the face. 

Special Causes. — Roseola is often symptomatic of other diseases. 
When idiopathic, it is produced by sudden and extreme alternations of 
temperature, drinking very cold water after violent exercise, etc. Gum 
rash is produced by coarse woolen clothing, uncleanliness, greasy and 
highly-salted food, and various other bad dietetic habits of either moth- 
er or child. Lichenous rash is more frequently attributable to morbid 
bile than to any other single cause; and when a torpid liver is connected 
with an obstructed skin, and both of these conditions with a high sum- 
mer temperature, we have the causes of its worst forms. Dr. Good 
remarks : " So far as I have seen, the varieties of this disease depend 
upon a peculiar irritability of the skin as its remote, and some acci- 
dental stimulus, as its exciting cause." If there is any thing but " su- 
perfluous nonsense" in such a flourish of words, I am no judge of the 
article. Pruriginous rash is more especially attributable to retained 
perspirable matters, and these have their cause in cutaneous uncleanli- 
ness. Some authors have imputed this form of skin disease to a fish 
diet. Millet rash, Dr. Good imputes to "a torpid state of the cutane- 
ous excretories, or rather of their mouths or extremities, which are ob- 
structed by hardened mucus." This is a roundabout but very delicate 
way of representing the idea of a dirty skin. 

Treatment.- — I have many times in the course of this work had oc- 
casion to characterize the popular practice in relation to certain dis- 
eases as barbarous, unphilosophical, absurd, pernicious, etc. I have 
used these terms deliberately, conscientiously, and, in my own estima- 
tion at least, understandingly. But if I were to express an honest opin- 
ion of the ordinary drug-medicatior in the whole range of skin dis- 



DISEASES OF THE SKIN. 303 

eases, I should apply to it all the preceding epithets, and add to them 
the little word silly. The ridiculous was never at a remoter distance 
from the sublime, than is the prevailing drug-treatment in affections of 
the skin, from true science. 

The common, every-day remedies in the majority of skin diseases, 
are mercury in its most potent forms of corrosive sublimate and red 
precipitate, arsenic, antimony, iodine, preparations of lead, copper, zinc, 
and other minerals, with a formidable list of irritating and narcotic oint 
ments, all of which tend to repel the disease to the internal parts, besides 
poisoning the system with the drug-remedy. Many an adult has been 
indebted for a fatal disease, and many a child for a ruined constitution, 
to the medication of a skin disease. For a single illustration — and 
thousands like it mighC be quoted from standarG medical books — Dr. 
Good, who ascribes millet rash to an obstructed skin, instead of telling 
us how to clear out the obstruction, prescribes "lotions of brandy, 
spirit of wine, tincture of myrrh, a solution of sulphate of zinc with a 
little brandy added to it.". 

The hydropathic management is intended to answer two indications ; 
1. To allay the local irritation ; 2. To purify the blood and all the secre- 
tions. In almost all cases of excessive irritation of the skin, unaccom- 
panied with fever, tepid water is preferable to very cold for bathing pur- 
poses. The pack, followed by the half-bath at about 72°, with moderate 
rubbing or friction, is one of the best leading processes. The half-bath 
alone, if accompanied with a rigidly plain and abstemious diet, will 
generally very soon effect a cure ; and the same may be said of the 
dripping-sheet ; in fact almost any kind of washing, if sufficiently fre- 
quent, with a plain diet, will cure in due time. There are no diseases 
in which stale meats, highly-salted or highly seasoned foods, greasy 
mixtures, and excessive alimentiveness, have a more pernicious influ- 
ence than in the affections under consideration. It is also of soma 
importance to preserve a uniform temperature of body, avoiding all 
extremes of heat or cold, and especially damp, chilly winds. When 
the itching or pricking is unendurable, the full warm-bath may be ad- 
vantageously employed as an occasional sedative. 

Scaly Eruptions. — The first variety, dandruff, consists in patches 
of fine branny scales, easily separated from the cuticle, which is not 
irritable or tender. It may affect the head, trunk, or whole body ; in 
the latter case the scaliness is red, brown, or yellow. 

Leprosy — lepra — lepriasis — presents patches of smooth laminated 
scales, of a circular form, and of different sizes, surrounded by a red- 
dish prominent circle, with a central depression , scattered generally 



304 PATHOLOGY AND THERAPEUTICS. 



over the surface. Its principal sub-varieties are the common or white 
leprosy, and the black leprosy ; so called from the color of the scales, 
■which varies from a bright white to a dusky brown. In some cases 
the scales exist in scattered patches and in others in confluent clusters. 
It has generally been regarded as contagious, although some authors 
dispute its contagiousness altogether. 

Psoriasis — dry scall — rough scabies — consists in bright patches of 
continuous scales, of indeterminate outline, generally appearing in ser- 
pentine or tortuous stripes, and found chiefly on the back and face, 
Dut sometimes extending over the whole body. In children it is con- 
sidered contagious. The surface is often chapped and excoriated, and 
itches or burns whenever exposed to unusual heat. A sub-variety of 
this affection has been called grocer's itch, baker's itch, etc. It fre- 
quently affects the hands of grocers, bakers, bricklayers, washerwomen, 
and bleachers, especially in the spring and fall. 

Ichthyiasis — -fish skin — is a harsh, papulated, watery rind, or horny 
incrustation, of a dusky, brown, or yellow color, sometimes covering 
the whole body, except the head and face, palms of the hand, and 
soles of the feet; and sometimes the entire body, including the face 
and tongue. In some cases horn-like excrescences sprout out of the 
incrustations, and occasionally grow to the extent of several inches. 
It is regarded by authors as a morbid development of the cuticle, and 
is generally congenital. 

Special Causes. — Gross food, personal uncleanliness, and sudden al- 
ternations of temperature, are the ordinary causes. Dandruff in the 
head is often produced by too much head apparel, greasing or oiling 
the hair, confining it too closely on the head, and excessive brain labor. 
That leprosy was regarded as emphatically a disease of bodily impu- 
rity, when it; prevailed among the ancient Hebrews, is evident from 
the whole tenor of the code of the Jewish law-giver on the subject 
of personal cleanliness, especially as related to the food of his people, 
and the rigid measures of purification deemed necessary in the treat- 
ment of lepers under the Mosaic dispensation. 

Treatment. — The principal point of difference in the management of 
cutaneous rashes and scaly eruptions is this : in the latter, on account of 
the less degree of irritability or tenderness of the skin, water of a colder 
temperature may be employed, and considerable friction can generally 
follow the bath with advantage. Probably the most efficacious treat- 
ment in a majority of cases, would be the long pack, from one to two 
hours — using two or three thicknesses of the wet-sheet, followed by a 
thorough rubbing with the dripping-sheet. Of course, when there is 
no preternatural or feverish heat, due precautions must be taken to 



DISEASES OF THE SKIN. 805 

secure proper reaction or a comfortable glow after each pack. Dan- 
druff of the body can always be cured by a persevering employment 
of the wet towel ; and when the head is badly affected, so that the 
hair is loose and easily falls out when the comb is used, the hair should 
be worn rather short, and the head bathed once or twice a day in very 
cold water. 

Blaiks. — These affections consist in roundish elevations of the 
cuticle, containing a watery fluid. 

In water-blebs — pompholyx — the eruptions, which are mostly dis- 
tinct, and break and heal without scale or crust, contain a reddish 
transparent fluid. They appear successively in various parts of the 
body, of the sizes of peas, filberts, or walnuts, sometimes bursting and 
healing in three or four days, but occasionally forn.ing an ulcerated 
surface. 

Tetter — herpes — is an eruption of vesicles in small distinct clusters, 
with a red margin ; transparent at first, but soon becoming opaque ; it 
is attended with tingling or itching, and the vesicles concrete into scabs, 
and desquamate in the course of two or three weeks. It presents 
several sub-varieties, as miliary, when the vesicles are millet-sized ; 
corrosive, when the vesicles are hard and discharge an acrid, corroding 
fluid, which spreads in serpentine trails ; shingles, when the vesicles 
are pearl-sized, and spread in clusters around the body like a girdle; 
ringworm, when the vesicles have a reddish base, and are united in 
rings; rainbow-worm, when the vesicles, which unite in small rings, are 
surrounded by larger concentric rings of different hues, and local, when 
they are limited to a particular part. 

In rhypia — -rhupia — sordid blain — the eruption consists in broad, 
distinct vesicles, having a slightly inflamed base, and filled with a sa- 
nious fluid, which often produces gangrenous and offensive eschars. 
The scabs are thin and superficial, and easily rubbed off and repro- 
duced. 

Eczema — heat eruption — consists in minute, distinct, but closely 
crowding vesicles, containing a transparent or milky fluid, attended with 
troublesome itching or tingling, and terminating in thin scales or scabs. 

Special Causes. — Rayer, who has written an elaborate treatise on 
diseases of the skin, assigns " chronic vascular inflammation or irri- 
tation," as the nature, cause, sum and substance of nearly the whole 
catalogue, while Drs. Good, Cooper, and Thompson, equally eminent 
authors, dispose of this branch of the subject quite as conveniently by 
the phrase, "a peculiar irritability with debility, either general or 
local" — phrases which i am sorry to say I cannot divino the meaning 



306 PATHOLOGY AND THERAPEUTICS 

of. Indigestible food and intoxicating liquors are the ordinary causes 
of water-blebs. Tetter is generally owing to acrid bile, thrown upon 
the surface. Rhypia almost always affects children who have been 
reduced by bad nursing and bad drugging. Heat eruption is usually 
produced by violent exercise, exposure to hot air, or the direct rays of 
the sun, and not unfrequently by the use or abuse of mercury . 

Treatment. — In addition to the general plan of treatment recom- 
mended thus far for skin diseases, the digestive function, being more 
particularly implicated in the diseases before us, requires some special 
additional attention. In all the varieties of tetter or herpes, free water- 
drinking, frequent hip-baths, and the abdominal girdle are appropriate. 
In the sordid blain of children, the parts affected should be frequently 
washed in very cold water, except when the abraded surface is itchy 
and tender, when warm or tepid washing is the most soothing. 

Humid Scalls. — The present genus of scall or scale-skin diseases 
is characterized by an eruption of small pustules, either distinct or 
confluent, which harden into crustulnr plates. 

Impetigo — running scall — appears in yellow, itching, clustering pus- 
tules, terminating in a yellow scaly crust, intersected with cracks. It 
is generally confined to the hands and fingers, but sometimes extends 
over the lower extremities, and occasionally affects the neck and face. 
A thin ichor or purulent matter often issues from the numerous cracks, 
which corrode the skin and cellular membrane ; and in some cases tho 
aggregated scabs form a thick, rigid casing around the affected limb so 
as to impede its motion. Sometimes the disease commences with a 
puffy swelling of the face, with oedema of the eyelids, very much re- 
sembling erysipelas, but without its smooth polish. 

Porrigo — scabby scall — tinea — consists of straw-colored pustules, 
which concrete into yellow scales. Its principal sub-varieties are, the 
milky scall, or crusta lactea, which chiefly affects infants at the breast, 
the pustules commencing on the cheeks and forehead, and often cover- 
ing the whole face with a continuous incrustation; and the scalled 
head — tinea capitis — found mostly in young children, marked by pus- 
tules which commence in the scalp in distinct patches, and gradually 
spread until the whole head is covered, and the roots of the hair de- 
stroyed. It is generally regarded as contagious. Other less important 
forms have been called lupine, honeycomb, furfuraccous, ringworm, etc. 

Ecthyma — papulous scall— is characterized by large, distinct pus- 
tules, raised on a hard red base, and terminating in hard, greenish, 
or dark-colored scabs. It occurs at. all periods of life, from the earliest 
infancy to advanced age, and is very often symptomatic of other diseases. 



DISEASES OF THE SKIN. 307 

Scabies — itch — is an eruption of minute pimples of a papular, pustu- 
lar, vesicular, or mixed character, accompanied with intolerable itching; 
it is found chiefly in the flexures of the joints or between the fingers, 
and is highly contagious. It is one of the most complicated of the cu- 
taneous diseases, presenting many sub-varieties, the principal of which 
are the papular or rank itch, the vesicular or watery itch, the purulent 
or pocky itch, the complicated, in which the disease extends over the 
body, often affecting the face, and the mangy itch, which is produced 
by handling mangy animals. 

Special Causes. — Most of the forms of humid scalls are owing to 
the combined operation of two sets of causes, one of which is nega- 
tive and the other positive. The negative causes are the absence of 
water, soap, flesh-brushes, and coarse towels , the positive, are gross 
and irritating food, as fried pork, salt ham, sausages, old cheese, fried 
cakes, and cooked and burnt fats of all kinds, and acrid or stimulating 
drinks, as hard cider, acid wines, and ardent spirits. Some forms of 
humid scall, which are confined to the hands and feet, are occasionally 
produced by severe exposures to cold or wet ; a remark which holds 
true also of some forms of dry scall which are confined to the ex- 
tremities. Mothers ought to know that their dietetic habits may induce 
these and many other cutaneous diseases in their offspring while nurs- 
ing, and even before birth. 

Treatment. — Thorough and frequent ablutions, with a plain vegeta- 
ble diet, and the constant use of wet compresses when the skin is 
abraded or ulcerated, comprise the general remedial course. The 
patient should be kept in a moderate uniform temperature, and when 
the hands or feet are deeply cracked, sore, and exposure is inevitable, 
the sores should be anointed occasionally with olive oil or sweet cream, 
taking the precaution to wash or soak the part in warm water before 
applying it. Parents, as they value the future health of a child, 
should avoid all repellant lotions, ointments, or all-healing specifics, in 
all forms of skin diseases. They may indeed smooth the skin, but the 
disease will be only transferred to an internal and more vital part. 

The whole system of allopathic medication is calculated to drive the 
disease in ; but all rational practice will contemplate the exact contrary. 
On so simple a disease as the common itch, which is always cured as 
soon as the skin can be made clean, nearly the whole force of the 
apothecary shop has been spent in vain; and the disease has been 
cured by two or three thorough soap-sudsings, after sulphur, lead, 
mercury, arsenic, tar, turpentine, human and animal urine, chalybeate 
waters, gunpowder and whiskey, gin and salts, and white and red pre- 
eipitate ointments had been used without success. 



308 PATHOLOGY AND THERAPEUTICS. 

Cutaneous Vermination. — The cuticle may be.infested with the 
common louse, which mostly inhabits the heads of uncleanly children ; 
the crablouse, which is found chiefly about the groins, pubes, and eye- 
brows of unhealthy persons, producing extreme itching ; the common 
flea, whose eggs are deposited on the roots of the hair and on flan- 
nel ; the chiggre, a West Indian flea, not more than one fourth the 
3ize of the common flea, which deposits a bunch of minute eggs in 
the feet of dirty persons, sometimes occasioning ulceration and mortifi- 
cation ; the tick, of which there are several varieties — the domestic 
tic, itch tick, and harvest bug — whose bite occasions an itching and 
smarting pain; the Guinea-ivorm of the Indies, the gad fly, which 
is common to quadrupeds, but sometimes burrows in the mucous mem- 
brane of human noses ; and the hair worm, which, by the way, in- 
volves a disputed point, whether the infestment is a live animal, or 
merely a morbid growth of real hair. 

Personal cleanliness is the best preventive of these intrusive crea- 
tures, and cold compresses are the best remedies when bitten by any of 
them. The second variety, crab louse, is often excessively troublesome. 
Medical books tell us that strong mercurial ointment is sure death to 
them ; and the same may be said of strong soap-suds, or a sufficient 
amount of cold bathing and friction without the soap. 

Macular Skin. — Simple discolorations of the surface are generally 
the result of depraved secretions, retained excretions, the introduction 
of drugs or foreign substances in the body, blows or bruises, or of ex- 
posure to strong cold winds or hot sunlight. Sometimes, however, a 
change in the color of a part or of the whole skin takes place, which 
we are unable to trace to either of these causes ; and one example — 
cyanosis — is frequently owing to organic malformation of the heart. 

In the veal skin variety the skin is marked by white, shining, per- 
manent spots, the superincumbent hairs falling oft* and never reappear- 
ing. The mole is a permanent, circular, brown patch, sometimes 
slightly elevated, and crested with a tuft of hair. Freckles are yellow- 
ish-brown dots on the cuticle, resembling minute lentil seeds, and often 
transitory. Sunburn is a tawny discoloration from exposure to the sun, 
which disappears in the winter ; orange skin is mostly confined to 
young infants whose mothers wero affected with torpidity of the liver 
during gestation, but it sometimes appears in adult life from biliary ob- 
struction. Piebald skin is a general marbled appearance of the cuti- 
cle, with alternate patches of black and white. Albino skin is a dull- 
white state of the cuticle, with rosy pupils, weak sight, and white or 
flaxen hair ; it is usually found among negroes, but is somotimos known 



DISEASES )F THE SKIN. 809 



among the white races ; it is sometimes congenital, and in some instan- 
ces the adult black and also white, have changed to Albinoes. 

Cyanosis — blue disease — cyania — is known by the whole skin being 
more or less blue, the lips purple, with general dullness of mind and 
debility of body; it is always congenital. 

Special Causes. — Severe fevers have been followed by various per- 
manent discolorations ; even a black man has been transformed into a 
white man by this cause. In some cases, spotted and motley-colored 
skins are hereditary. Mineral medicines often produce livid spots or a 
universal dingy, bluish, or dark appearance of the skin. Nitrate of sil- 
ver is a very common cause. When administered for several weeks, 
it frequently produces a deep tawny and uniform discoloration, ap- 
proaching to a black, being deepest in the parts most exposed to the 
light. Sometimes, however, discoloration from this drug appears in 
patches, and sometimes one half of the body is affected. 

The blue disease is generally owing to some malconformation of the 
heart, the most common of which is a communication between the two 
ventricles, thus rendering the decarbonization of the blood imperfect, 
and giving rise to the venous or carbonaceous discoloration. Nitrate 
of silver has also produced a bluish tinge of the whole skin, closely re- 
sembling cyanosis. 

Treatment. — Most of these affections are unimportant trifles, and 
many of them are unalterable for the better. Yellow skins, blotches, 
motley appearances, etc., when induced by a diseased liver, can be 
often cured by restoring the functional action of this organ. When 
the skin is discolored by drugs, a persevering employment of the wet- 
sheet, with a course of free water-drinking and plain vegetable diet, 
will do all that can be done in the way of medication, although it will 
seldom wholly remove the difficulty. The blue disease is incurable ; 
its subjects are feeble and short-lived ; and all that can be done to pro- 
long existence is found in plain, quiet, simple habits of life. 

Morbid Sweat. — Profuse perspiration, when not a symptom of 
some acute disease, is an evidence of debility, and requires no atten- 
tion, save a course of tonic bathing and regimen. Bloody sweat, though 
regarded as an idiopathic disease by some authors, is usually a vica- 
rious affection, as in mis-menstruation, or the result of vehement emo- 
tion, violent exertion, or intense agony. Partial sweats are, I believe, 
always symptomatic. Colored stveals, which may be green, blue, black, 
or vfi"' — "■•■' Tom obstruction of the liver or kidneys, or fr< 
itic impregnation. Scented sweat may be ra 
d, sulphurous or musky, saline, aromatic, er 



310 PATHOLOGY AND THERAPEUTICS. 

of these varieties depend on the dietetic habits of the individual, in ion 
nection with the amount of bathing practiced. Some persons, who 
never or but seldom bathe, and eat strong food, are exceedingly disa 
greeable to the olfactory nerves of others. Many persous who exer- 
cise much on foot, wear flannel stockings, and bathe rarely, have a 
horribly offensive scent, which becomes intolerable on exposing the feet 
to the fire. I once had a patient who exhaled from the axilte a strong 
musky, or rather blue-dye odor, for which he could assign no probable 
cause. Sandy sweat, known by a i-eddish sandy material concreting on 
the surface, indicates great deficiency in the functional action of the 
kidneys, or great excess in the saline and earthy matter taken into the 
system with the ingesta. The proper treatment, I trust, is sufficiently 
obvious in all these cases without further remark. 

Morbid Hair — Trichiasis. — Even the hairs of our heads may be- 
come deranged by our physiological transgressions, although, next to 
the bones, they are the most indestructible of our bodily constituents. 
The bristly or porcupine hair, is usually regarded as an effect of gross 
nutriment connected with general habits more congenial with perfect 
animal than progressive human nature. Matted hair — plica polonica 
— the hairs becoming vascularly thickened, inextricably entangled, and 
matted together by a glutinous secretion — is supposed to result from 
covering the head too closely, as with a thick woolen bonnet or leather 
cap, with little or no attention to combing, washing, or in any way 
cleansing the head. Extraneous hair — trichosis — is most commonly 
noticed in bearded women, and has been imputed to excessive men- 
struation, the excessive use of pork, shell-fish, and other gross foods. 
Forky hair — the hairs of the scalp weak, slender, and splitting at their 
extremities — is a common complaint, depending for its immediate 
cause on defective nutrition in the bulb or root. Gray hair, when not 
"frosted by age," may be produced by fright, terror, grief, excessive 
brain labor, violent fevers, etc. Baldness may result from the same 
causes as gray hairs, and is often the consequence of skin diseases. It 
is far more common in males than in females — which fact seems to 
corroborate the physiological notion which some have advanced, that 
the common practice of catting the hair and shaving the beard is a 
source of bodily infirmity. Aerated hair — patches of bald spots in the 
scalp or beard — is probably owing to some obscure skin disease or pre- 
ternatural excitement of some portion of the brain. WKscolored hair 
— the hair changing to blue, black, green, or spotted — occasionally re- 
sults from fevers, terror, heating the head, mineral and metallic va- 
pors, etc. Sensitive hair is usually owing to cerebral excitement- and 



-'OISONS. 311 

this is usually owing to wounds or injuries of the head, and febrile or 
inflammatory affections. The hair, in some instances, is so acutely 
sensitive that the slightest touch, or the cutting of a single hair, gives 
exquisite pain. 

Treatment. — Cutting the hair short, and frequently bathing the 
whole head in cold water, is the general restorative process in these 
deviations from health — some of which, however, are not curable. In 
cases of excessive sensibility or tenderness, tepid or moderately warm 
water should be employed. In the plica polonica, the hair should be 
cut very close, the scalp frequently washed with tepid water, and de- 
rivative hip and foot-baths directed. And in all cases the general reg- 
imen must be physiologically regulated, and such bathing appliances 
brought in requisition as the general health and particular circum- 
stances indicate. 



CHAPTER XXI. 



So general is the employment of substances for chemical, mechan- 
ical, and medicinal purposes, which are poisonous to the living organ- 
ism, whether taken into the stomach or applied to the skin ; and so nu- 
merous are the emergencies wherein relief must be either immediate 
or impossible, that a work of this kind would be sadly defective with- 
out a brief consideration of this branch of pathology and therapeutics. 

Toxicologists have usually classified poisons according to the king- 
doms from whence they are derived, as mineral, vegetable, and ani- 
mal. Some have arranged them according to their action on the ani- 
mal economy, and others have merely distinguished them into general 
and local. Christison, who has written the most elaborate work on 
this subject, divides them into irritants, narcotics, and narcotic-acrids. 
The first embraces all poisons whose principal symptoms are those of 
irritation or inflammation; the second produce stupor, delirium, spasms, 
paralysis, etc. ; and the third, as the term implies, produce either or 
both sets of symptoms, according to the dose and other circumstances. 

But what are poisons ? This is a problem not yet settled among 
medical men. In its broadest sense, the term must comprehend every 
thing foreign to the natural constituents of the human body, and even 
these constituents themselves, when their constituent elements are in 



812 PATHOLOGY AND THERAPEUTICS. 

unnatural relations or proportions; every thing, in a word, which is 
not properly food, drink, or atmosphere. This latitude of definition 
will include the whole materia medica of our allopathic friends ; and in 
truth, almost every poison known is an integral part of that materia medi- 
ca. Established usage has, however, restricted the idea of poison to 
the sudden, prominent, aod immediately-dangerous effects of these 
articles, while their equally morbid yet more slow, gradual, and remote 
consequences are called diseases. 

Were I to attempt — what no toxicologist has yet accomplished — a 
satisfactory and philosophical arrangement of poisons, I should base it 
on the allopathic materia medica, as tonic poisons, stimulant poisons, 
emetic, cathartic, diaphoretic, expectorant, vermifuge, and escharotic poi- 
sons, etc. ; but whether such a classification would be pathological or 
therapeutical, is a question I am willing to submit to " future genera- 
tions." In the present chapter, the effects of large or poisonous doses 
will be chiefly considered, and small or medicinal doses only incident • 
ally alluded to. 

Acids. — The nitric, sulphuric, muriatic, or hydrochloric, phophoric, 
oxalic, and acetic acids, are corrosive poisons ; and whether taken inter- 
nally or applied externally, produce redness, inflammation, vesication, 
and ulceration. 

Symptoms. — When swallowed, a burning sensation in the throat, ex- 
cruciating pain in the stomach, and gaseous eructations are usually the 
immediate effects. When taken in extremely large doses, the sensi- 
bility may be so suddenly destroyed that the pain will be deceitfully 
slight. All the symptoms are most severe when the poison acts upon 
an empty stomach. 

Treatment. — All alkalescent matters are chemically antidotes ; there 
is, however, a choice, for the reason that some alkalies are themselves 
extremely corrosive. Chalk and magnesia are the best. A solution 
of nard soap answers very well. Slaked lime, or carbonate or supercar- 
bonate of soda may be given ; and in the absence of all these, a remedy 
may be found in the common plaster of an ordinary room, which may 
be beat down in a moment and made into a thin paste with water. The 
patient should drink as much water as he can swaHow conveniently. 
The stomach-pump is not necessary. 

Alkalies. — Caustic potash, saleratus, quick-lime, salt of tartar, 
pearlash, soda, sal ammoniac, carbonate of ammonia, or smelling salts, 
and spirits of ammonia, or hartshorn, are the usual alkalies from which 
accidental poisoning results. 



POISONS. 813 



Symptoms. — These do not differ essentially from those produced by 
the strong acids. 

Treatment.— Of course, all acids are antidotal. Vinegar, lemon- 
juice, or any of the stronger acids, largely diluted, may be given. In 
the absence of acids, any of the fixed oils, as olive 01 almond, by con- 
verting the alkali into a soap, will neutralize its corrosive effects. In 
other respects, the treatment is the same as for acid poisons. The 
resulting inflammation, in all cases of poisoning, is to be treated pre- 
cisely like inflammation from other causes. 

Neutral. Salts. — The most virulent of the preparations commonly 
known as neutral salts is nitrate of potash — saltpetre, nitre, sal-prunelle. 
In the apothecary-shops mistakes are often made, by which this article 
is put up for sulphate of soda, sulphate of potash, and other saline lax- 
atives, so that the patient gets poisoned. It produces stinging pains in 
the stomach, and the usual symptoms of a violent cholera, with cold- 
ness, debility, and great exhaustion of the nervous system. Other neu- 
tral salts in common use, as Glauber and Epsom, are not dangerous ex- 
cept in excessive doses ; the symptoms then are drastic purging and 
great debility. 

Treatment. — We have no direct antidotes in the cases before us, 
and our duty is chiefly to combat inflammation. When nitre has been 
swallowed, warm water must be freely taken, and the stomach-pump 
employed if practicable. Wet bandages to the whole abdomen are 
called for, and the warm-pack is often serviceable. The effects of the 
other neutral salts are to be counteracted by cool or cold injections, 
and warm hip-baths. 

Mercury — Hydrargyrum. — The most actively-poisonous of the 
salts and oxides of mercury in common use, are calomel, turpeth min- 
eral, corrosive sublimate, red precipitate, cinnabar, vermillion, and cy- 
anuret. Of these, red precipitate and vermillion are most frequently 
the agents of accidental poisoning ; while calomel and corrosive subli- 
mate are the common agents in medicinal and suicidal poisonings. It 
is a serious fact, among the "curiosities of medical literature," that 
the standard books recognize fifty-one distinct diseases resulting from 
the medicinal administration of the various preparations of mer- 
cury ! 

Symptoms. — When very large doses are taken, especially of the 

more powerful of the mercurials, there is violent pain in the stomach, 

intense thirst, vomiting, heat and fever. When corrosive sublimate has 

been given in large doses, or when small doses have been a long time 

11—27 



SU PATHOLOGY AND THERAPEUTICS. 



continued, there is a griping pain in the bowels, with a tendency to di- 
arrhoea. When the system is slowly and gradually saturated with the 
poison, the effects are distinguished by the general term salivation, the 
symptoms of which are general fever, tremors, fceted breath, brassy taste, 
sore "urns, loosened teeth, driveling at the mouth, swelled tongue, and 
often ulcerated bones. In some cases the tongue is enormously swollen, 
and protrudes hideously from the mouth, the poor poisoned patient 
being unable to articulate or swallow. 

Treatment. — When a large dose of corrosive sublimate has been 
swallowed, albumen or gluten will decompose the salt and prove an 
effectual antidote. The albumen may be found in the white of eggs, 
and the gluten in wheaten flour. Either may be given freely ; the 
white of eggs being previously beaten up with water or milk, and the 
flour may be administered in either water or milk. In the absence of 
either eggs or flour, milk is the next best antidote. 

To cure salivation, and remove mercury and its effects from the 
system, require a persevering employment of the packing-sheet, 
which may be warm, tepid, or cold, according to the susceptibility of 
the patient, and so managed as to produce moderate but frequent per- 
spiration. 

When paints, ointments, etc., which contain some form of mercury, 
are accidentally swallowed, the patient should drink copiously of warm 
milk made into a very thin batter with wheaten flour, and, if the acci- 
dent is soon discovered, the stomach-pump should be employed. 

Arsenic — Arsenicum. — The arsenical preparations from which 
poisoning occasionally results are, the frotoxide, or fly-powder ; arse- 
nious acid or white arsenic, commonly called ratsbane ; arsenite of cop- 
per or mineral green ; arsenite of potass, as in Fowler's solution ; 
arseniusetled-hydrogen gas, which is evolved in various chemical opera- 
tions ; and several sulphurets of arsenic, as realgar, orpiment, and 
king's yellow. 

Symptoms. — In a great majority of eases there is violent irritation 
and inflammation of the whole alimentary canal ; a burning pain in the 
throat and stomach, which soon extends over the whole abdomen, with 
nausea, faintness, and extreme prostration of strength. In some cases,, 
however, the pain is slight, the nausea and vomiting moderate, but the 
vital depression excessive and alarming, and often attended with con- 
vulsions, paralysis, insensibility or delirium. When rtrsenic has been 
given medicinally in small doses for some time, the first prominent 
symptom of its specific action- on the system is a peculiar puffmess of 
the whole face, called in medical parlance mdema arsenicalis, and 



POISONS. 315 



attended with redness of the eyes, and followed by gripings, nausea, 
purgings, and a gradual sinking of the vital powers. 

Treatment. — The stomach-pump should always be resorted to at 
once, if possible. If this is not at hand,, the patient should drink co- 
piously of warm water, and have the throat tickled with the finger or 
a feather to excite vomiting. We have no antidote, in the chemical 
sense, and medical books recommend a variety of diluent and demul- 
cent liquids, to involve the poisonous matter and thus indirectly defend 
the coats of the stomach. Flour and water, and olive oil, are com- 
plete substitutes for the whole list. Some authors advise large quanti- 
ties of the hydratcd scsquioxide of iron ; but its value is uncertain and 
far from being reliable. 

To remove the subsequent inflammation and counteract the effects 
of the poison, Dr. Pereira tells us: "Our principal reliance must be 
on the usual antiphlogistic measures, particularly blood-letting, both 
general and local, and blisters to the abdomen. One drawback to the 
success of this treatment is the great depression of the vascular sys- 
tem, so that the patient cannot support large evacuations of blood" — the 
same as to say, the patient must bo bled on theory, although it will kill 
him in practice. 

Antimony — Antimokiiim. — Accidental poisonings with antimonial 
preparations aro uncommon ; but, medicinal poisonings are extremely 
frequent. Death very often results from an over-dose of tartar 
emetic ; and this deadly drug is extensively diffused amonj' us, being a 
common ingredient in candies, lozenges, cough mixtures, drops, and 
syrups, etc. The popular preparations of the regular pi larmacopieias, 
James'' powder, and Plunimers 1 pill, are strongly charged with this 
dangerous drug. Besides tartar emetic, the oxide or sesquioxide of 
the metal, called jloiocrs of antimony, and the chloride, are sometimes 
the agents of accidental poisoning. 

Symptoms. — Small doses produce scarcely any obvious effect save 
general debility. Large doses produce epigastric pain, vomiting, and 
often purging. In very large doses it occasions extreme muscular re- 
laxation, nausea, depression, vital exhaustion, sometimes convulsions 
and death. Applied to the skin, tartar emetic produces an eruption of 
painful pustules resembling small-pox. Death has resulted from the 
absorption of the drug, when it has been applied to an abraded surface. 
Treatment. — Our main reliance must be on the warm water emetic, 
in the early stage, and the usual " antiphlogistic" water-treahnent in 
the later stages. Persons who are severely poisoned with any form 
of antimony are always cold, torpid, sensitive, and debilitated, so that 



816 PATHOLOGY AND THERAPEUTICS. 



our bathing appliances must be gentle and of moderate temperature. 
The warm-bath is excellent to check excessive evacuations when a 
large dose of the drug has been taken. Medical books recommend 
astringents, as tea, nntgall, cinchona, etc., on the supposition that tannic 
acid is antidotal to tartar emetic. But the numerous experiments which 
have been tried do not establish its claim to this title. 

Lead — Plumbum. — All the preparations of this metal, except the 
sulphurets, are energetic poisons. The acetate — sugar of lead — sac- 
charum saturni, is the form in which it is usually given internally as a 
remedy. The preparations from which accidental poisonings chiefly 
result are, litharge — the protoxide of lead ; red lead — the red oxide, or 
deutoxide : white lead — carbonate of lead ; and Goulard's extract — the 
diacetate. Milk, molasses, and even pure water, may acquire a poi- 
sonous property by standing in leaden vessels. Red earthen-ware 
ought never to be used for cooking fruit or pastry, on account of its 
lead glazing; indeed all colored crockery ought to be "ruled out" on 
account of its metallic coloring matter. 

Symptoms. — Small doses check the secretions generally, and consti- 
pate the bowels. Large doses constringe the circulating vessels, re- 
duce the pulse, diminish the temperature of the body, produce dry- 
ness of the mouth and throat, and a general wasting of the body. In 
most cases of lead poisoning there is a narrow leaden-blue line border- 
ing the edges of the gums, attached to the necks of two or more teeth 
of either j-iw ; the saliva is often bluish. The extreme effects are 
lead-colic. Excessive doses produce more or less gastro-enteritis. 

Treatment. — The warm water emetic must be given in the first 
instance, and the stomach-pump employed if practicable. The soluble 
alkaline or earthy sulphates, or the alkaline carbonates, will lessen the 
injurious effects of the preparations of lead, by changing them to sul- 
phates. For this purpose phosphate of soda, alum, Glauber or Epsom 
salts are appropriate. These chemicals are unnecessary when the 
vomiting has been thorough or the stomach-pump introduced. The 
treatment for lead-colic has already been given. 

Copper — Cuprum. — The salts of copper have been much em- 
ployed in the manufacture of culinary vessels, and to color candies, 
sweetmeats, and preserves, from which frequent poisonings have re- 
sulted. The preparations in common use are mineral green — the 

nydrated oxide ; blue vitriol — the sulphate ; natural verdigris the 

carbonate ; and artificial verdigris — the mixed acetates. 

Symptoms. — These are quite various. In email doses they are 



\ . % POISONS. 817 

manifested by cramps, paralysis, discolorations of the skin, slow fever, 
wasting of the body, chronic inflammation of the stomach and lungs, 
etc. In large doses, nausea, vomiting, coppery taste, eructations, 
griping pains, and giddiness result. Very large doses produce convul- 
sions and insensibility, with the usual symptoms of gastro-enteric in- 
flammation. 

Treatment. — Wheaten flour, milk, and the white of eggs, are here 
our antidotes again. Vinegar has been a popular proscription, but it is 
actually injurious. 

Bismuth — Bismuthum. — There are two preparations of this metal 
in common use ; the first is the trisnitrate, which is extensively used 
in medicine, and known by the various names of oxide of bismuth, 
subnitrale of bismuth, and magistery of bismuth ; the second is the 
tartrate of the metal, and is extensively used in the cosmetic art under 
the name of pearl white. They are both caustic poisons. 

Symptoms. — Small doses diminish the sensibility, but large ones 
cause pain, vomiting, giddiness, gastric disorder, cramps in the extremi- 
ties, etc. The cosmetic preparation has produced spasmodic trembling 
of the muscles of the face, terminating in paralysis. 

Treatment. — We have no chemical antidote, and must rely on warm 
water, the stomach-pump, etc. 

Tin — Stannum. — The chlorides of tin, used in color-making and 
dyeing, and the oxide, which forms a part of the putty-powder for 
glass staining and silver plating, are the preparations of this metal 
which sometimes, though rarely, occasion poisoning. Powdered tin 
has been given in ounce doses to expel the tape-worm. The symp- 
toms of tin poisoning are similar, and the treatment the same as in the 
case of the preparations of bismuth. 

It ought to be known to housekeepers that acid, fatty, saline, and 
even albuminous substances, may occasion colic, vomiting, etc., after 
having remained for some time in tin vessels. 

Silver — Argentum. — Nitrate of silver — lunar caustic — though n 
powerfully corrosive poison, is extensively prescribed internally as a 
nervine, tonic, and astringent medicine. The chloride, oxide, and 
cyanide, are other preparations of the metal occasionally misapplied to 
the human stomach. 

Symptoms. — Applied to the skin, hair, or nails, nitrate of silver staina 
them black ; to an ulcerous surface it produces a white film ; and to 
a mucous membrane, smarting, pain, and inflammation, which lasts 



818 PATHOLOGY AND THERAPEUTICS. 



several hours. Taken into the stomach in small quantities, it produces 
no sensible inconvenience for some time ; but if large doses are given, 
or the small ones long continued, heartburn, nausea, and vomiting re- 
sult, and sometimes inflammation and mortification, especially when it 
has been taken medicinally for six months or longer. Its absorption 
into the system produces a blueness, slate color, or bronze hue of the 
skin, which is very difficult to remove. In some cases the whole 
body, internally and externally, has been blue-dyed by the medicinal 
operation of this drug. The discoloration results from a chemical 
combination of the salt with the organic tissues. 

Treatment. — When the drug has been recently taken into the stom- 
ach, common table salt will decompose it and render it comparatively 
inert. When the body has been pretty well saturated with it, a long 
course of hydropathic bathing and dieting will be necessary, even to get 
rid of its effects partially. 

Gold — Aurum. — The morbific and medicinal effects of the prepa- 
rations of the rex metallorum, as the alchemists termed gold, are similar 
to those of the mercurials, though they are generally more sudden and 
violent. Gold has been administered in the state of minute division — pul- 
vis auri — and in the forms of iodide, cyanide, and various chlorides. A 
preparation, called fulminating gold — aurate of ammonia — has been 
experimented with considerably ; and writers on materia medica tell 
us with sufficient coolness, that "it has produced very serious and even 
fatal results." 

Treatment. — The antidotes are albumen, flour and milk, as in the 
:ases of corrosive sublimate and the preparations of copper. 

Iron — Ferrum. — A very strange and general delusion pervades the 
medical profession respecting the medicinal virtues of this metal. Some 
chemists have detected, or imagined they have detected, a little of it 
in human blood; and, making a spring-board of this fact, have jumped 
to the conclusion that iron was a great remedy for a great many dis- 
eases. Even our "botanic," "eclectic," and "physopathic" co-reform- 
ers, who are so justly horrified at the idea of mercurial and antimonial 
poisoning, very freely mingle chalybeate waters and ferruginous salts 
and oxides in the preparation of their purifying syrups, alterative mix- 
tures, and tonic powders. If it be true that iron is in some form a nat- 
ural constituent of the human body, it does not by any means follow 
that the preparations of the metal which are found in the pha7 - maco- 
poe'ras are natural remedies, or remedies in any sense; nor does it fol- 
low that because phosphate and carbonate of lime are found in the 



POISONS 319 

bones, that common ckulk, mason's mortar, or plaster of Paris are nat- 
ural foods ! 

As iron was the first minora] introduced into medicine, the his- 
tory — all we have on the subject — of its introduction may not be un- 
interesting : " Me'iampus, a shepherd, supposed to possess supernat- 
ural powers, being applied to by Iphicles, son of Philacus, for a rem- 
edy against impotence, slaughtered two bulls, the intestines of which 
he cut to pieces, ia order to attract birds to an augury. Among 
the animals which came to the feast was a vulture, from whom Me- 
lampus pretended to learn that his patient, when a boy, had stuck a 
knife, wet with the blood of some rams, into a consecrated chestnut- 
tree, and the bark had subsequently enveloped it. The vulture also 
indicated the remedy, namely, to procure the knife, scrape oft" the 
fust, and drink it in wine for the space of ten days, by which time 
Jphicles would be lusty, and capable of begetting children. The ad- 
vice thus given by Melampus is said to have been, followed by the young 
prince with the most perfect success !" 

Iron is employed medicinally in the forms of filings ; black oxide, 
or ethiops martial ; sesqu.i6.vide — the red oxide, peroxide, or crocus 
martis, various preparations of which are known as carbonate of iron, 
vitrioli, brown-red, rouge, etc. ; hyd rated sesqaioxide ; ammonio-chlo- 
ride; iodide; swlphliret, or common iron pyrites ; ferro-sesquicyanide, 
or Prussian or Berlin blue ; ferro-cyaiiidc of potassium, or Prussiate 
of potash; sulphate — green vitriol — sal martis — copperas ; ferro-tar- 
trate of potash ; acetate ; persulphate ; pernitralc ; fcrro-tai Irate of am- 
monia ; lactate, and citrate. 

Symptoms. — The effects of the different preparations are exceeding- 
ly various, both in quality and degree. A few of them are violently 
irritating; but the majority are among the slow and insidious poisons. 
Small doses generally constringe and harden the fibres, constipate the 
bowels, and blacken the stools, and even reduce the size and harden the 
Structures of various glandular viscera, as the liver and spleen. Like 
nitrate of silver, they form compounds with the organic tissues. They 
increase for awhile the frequency and force of the pulse, augment the 
temperature of the body, and heighten the color of the cheeks : ef- 
fects indicative of fever and irritation, but which are usually regarded 
as remedial. Unfortunately the, general and preternatural excitement 
is, ere long, followed by corrresponding sinking and depression. The 
sulphate and chlorate of iron, in large quantities, produce great heat, 
weight, pain and uneasiness in the stomach, with nausea, vomiting, and 
sometimes purging and hemorrhages. 

Treatment. — We have no chemical antidotes except the alkalies, 



820 PATHOLOGY AND THERAPEUTICS. 

chalk, magnesia, etc., when the sesquichloride has been swallowed. 
This is usually obtained at the apothecary shop, in the form and under 
the name of muriated tincture of iron. Against all the other prepara- 
tions we must trust to warm-water vomiting, the stomach-pump, and 
the usual means for counteracting inflammation. 

Zinc — Zincum. — The compounds of zinc are analogous to those of 
copper in their action on the system, though somewhat less violent. 
The preparations iu common use are the oxide — flowers of zinc ; im- 
jiure oxide, or tutly ; chloride — muriate, or butter of zinc ; sulphate, or 
white vitriol ; acetate ; carbonate, or calamine ; and cyanide. The treat- 
ment is the same as in cases of copper poisoning 

Manganese — Manganesium. — The binoxide of this metal has been 
sometimes used in medicine. It is employed by potters to color earth- 
en-ware ; by glass-makers to destroy the brown color produced by iron, 
and to givo an amethystine tint to plate glass ; and by bleachers to pro- 
duce chlorine. It has also been used as a depilatory. Its effects on 
the human system are more severe than those of iron, but less injuri- 
ous than lead, and they are to be counteracted like those of the pro- 
ceding poisons. 

Iodine — Iodinum. — This is an intense and acrid irritant. In largo 
doses or small doses long continued, it causes a burning pain in the 
stomach, a colliquative and exhausting diarrhea, with a rapid emacia- 
tion of the whole body, and extreme prostration of the whole system. 
Its destructive action seems to bo particularly determined to tho 
glandular structures. In some cases the male testes, and in others tho 
female breasts, have been nearly absorbed and entirely destroyed by 
its medicinal employment. Its principal preparations are the hydrio- 
date ofpotassa, which is extensively used in preparations called "sar- 
sapariila," and is a frequent cause of paralytic limbs and weak joints ; 
and various combinations with sulphur und mercury, which are vio- 
lently corrosive. Unfortunately we are without antidotes once more, 
find must trust to the principles of treatment already explained. 

Phosphorous. — This article is in less repute for medicinal purposes 
at tho present clay than it was some fifty years ago. It is a powerful 
irritant, and its acid is corrosive. The antidotes are demulcents and al- 
kalies — albumen, gluten, milk, magnesia, etc. 

Sci-phur. — Various forms of this nrticlj nre familiarly known as 



POISONS. 321 



hrimstone, jloicer of sulphur , roll or cane sulphur, balsam of sulphur, 
milk of sulphur, etc. Their action on the animal economy is weak in 
small doses, producing chiefly those effects which are called laxative 
and diaphoretic. Its principal celebrity in medicine has been obtained 
from its success in curing the itch. 

Very large doses of sulphur sometimes produce severe griping and 
purging, with great debility, the treatment for which is the same as for 
an ordinary diarrhea. 

Chromk — Chromium. — The chromate of j>otass, and some other 
salts of this metal, are extensively employed in dyeing. When taken 
into the stomach, they produce the usual vomiting, griping, and purging 
effects of other mineral poisons ; but they are peculiarly liable to be fol- 
lowed by a degree of debility and paralysis wholly disproportion^ to the 
irritant effects. The treatment should be the same as for lead poisoning. 

Bromine — Brominum. — This substance has been employed medic- 
inally as a substitute for iodine, to which its operation is similar ; and 
when poisoning results from it, the treatment is the same. 

Aldm — Alumkk. — Taken internally, alum corrugates the fibres, 
diminishes the secretions, creates dryness and thirst; and when large 
quantities are swallowed, nausea, vomiting, griping, and purging suc- 
ceed. The remedies are, warm water and the stomach-pump. 

Platina — Platinum. — Some preparations of this metal, as the 
bichloride and chloroplatinatc of sodium, have been used in medicine 
and the arts. Their action on the human system resembles that of the 
preparations of goid; and Iheir antidotes are the same. 

Barytks — Barium. — The carbonate, chloride, and nitrate of this 
metal produce effects on the human system hardly distinguishable from 
those of arsenic. The clfloride has been administered in scrofulous 
cases. The antidotes are alum, and the sulphates of magnesia, lime, 
and soda, which form an insoluble salt or sulphate of baryta. 

Metallic Salts and Oxides. — There are many preparations of 
metals which it would be tedious to enumerate, which are irritant and 
corrosive poisons of greater or less intensity ; their effects are analo- 
gous to those of arsenic, copper, and lead, and in all cases of poisoning 
from them, our main reliance must be on vomiting and the stomach- 
pump ; the albumen of eggs and gluten of wheat are always harmless, 



822 PATHOLOGY AND THERAPEUTICS. 



and in some cases might bo serviceable ; hence it would be at least pru- 
dent to employ them in ail cases as auxiliaries. Among the most dan- 
gerous may be named the oxide of osmium and hydrochlorate of palla- 
dium, which are nearly as active as arsenic; the hydrochlorates of 
rhodium and iridium are rather less violent; the salts of molybdenum 
are comparatively feeble ; uranium and cobalt are more active ; tung- 
stein, cadmium, nickel, cerium, and titanium, in their various prepara- 
tions, are among the weakest of the metallic poisons. 

Narcotics. — These may be medicinally and toxicologically divided 
into the pure, stimulant, and acrid. The pure narcotics produco stu- 
por, insensibility, nervous prostration, paralysis, convulsions, etc., di- 
rectly, and without previous excitement, as Prussic acid, henbane, bel- 
ladona, strammonium, conium, cicuta, ergot, narcoline, lettuce, pink, 
cherry laurel. The stimulant narcotics produce at first more or less 
nervine excitement or exhilaration, with an increased action of the cir- 
culating system, followed by torpor, depression, debility, stupor, and all 
the symptoms of ultimate narcosis. To this division belong opium and 
and its various preparations of morphine, mcconic acid, code'ia, lauda- 
num, paregoric, black drop, Godfrey's cordial, and wine of opium; al- 
cohol in all its furms of intoxicating malted, fermented, or distilled 
liquors ; tobacco, camphor, cocculus indicus, nux vomica, St. Ignati- 
us' 1 bean, etc. The acrid narcotics produce violent irritation and in- 
flammation in the stomach and bowels, followed by stupor, delirium, 
prostration, etc. Among them may be named as prominent, mezereon, 
squills, serpentaria, cantharides, elaterium, colchicum, gamboge, jalap, 
scammony, colocynth, celandine, croton oil, bryony, savin, spurge lau- 
rel, aconite, bitter almonds, arnica, arum, rhus, cowhage, anemone, 
marsh-marigold,- daffodil, fools' parsley, seeds of the castor-oil tree, 
bitter-sweet, five-finger root, black, white, and green hellebore, meadoiu 
saffron, rue, ipecacuanha, yew, darnel-grass, creasote, etc. 

Treatment. — All cases of narcotic poisoning demand the stomach- 
pump or warm water emetic, or both, in the first instance ; the ulterior 
symptoms will be those of inflammation, partial apoplexy, or complete 
asphyxia, donoted by tremors, stupor, or insensibility, coma, delirium, 
convulsions, partial paralysis, etc. In this stage the treatment is nearly 
Hie same as for apoplexy. The extremities must be kept warm with 
hoi bottles, gentle but persevering friction applied to the surface, and 
the cold pouring-bath applied to the head ; this last is indeed the most 
important part of the treatment. Inflammatory symptoms are to be 
treated on general principles. When an exhausting diarrhea attends, 
«a from colchicum or elateritim, the joM -nndage nn d hot fomenta- 



POISONS. 823 



tions may be necessary, and may alternate with advantage, and small 
quantities of very cold water are to be frequently thrown up the 
rectum. 

Acrids. — There are many aromatic and pungent vegetable sub- 
stances not usually regarded as poisonous, but which, when taken in 
large quantities, produce severe irritation, and even fatal inflammation 
of the stomach and bowels. Of this class are the essential oils, As pep- 
permint, spearmint, cloves, cinnamon, and capsicum ; various balsams, 
as Tolu, copavia, Canada, and Peru; many condiments, as pepper, 
mustard, horse-radish, cloves, and nutmegs ; to which may be added 
turpentine, oil of tar, cubebs, and two or three hundred medicines be- 
longing to the classes of cathartics, diuretics, diaphoretics, vermifuges, 
emmenagogues, etc. The action of these articles on the system, or 
rather, the resistance of the vital powers to their action, is not accom- 
panied with the indications of nervous prostration or exhaustion pecu- 
liar to the narcotics proper ; hence our treatment is limited to soothing 
irritation and combating inflammation, premising, however, that the 
offending material is in all cases to be got rid of by emesis, catharsis, 
etc., as speedily as possible. 

Mushrooms. — The fly agaric, pepper agaric, deadly agaric, bul- 
bous agaric, and champignon, are the kinds of mushrooms from which 
poisoning most frequently results. They produce nausea, heat, and 
pain in the stomach and bowels, thirst, vomiting, griping, and purging ; 
in severe cases, convulsions and faintings are frequent, with small and 
frequent pulse, delirium, dilated pupil, and stupor, followed by cold 
sweats and death. 

Treatment. — Here again the scientific treatment of the books is emi- 
nently calculated to make a very bad matter very much worse : " emet- 
ics of tartar emetic, followed by large doses of Glauber or Epsom salts." 
As theso drugs have no antidotal property in the chemical sense, and as 
their employment is powerfully debilitating, they are as injudicious a 
selection for puking or purging purposes as it is possible to make. 
Warm water and the stomach-pump, with copious tepid injections, are 
our more rational practice. 

Poisonous Fish. — The kinds of "sea-food" from which poisoning 
most frequently happens, are, the crawfish, mussel, old-wife, yellow- 
billed sprat, land-crab, gray-snapper, dolphin, hyne, conger-eel, blue- 
parrot fish, smooth-bottle fish, grooper, rock-fish, barracuda, king-fish, 
Spanish mackerel, porgec^ ionetta, Mower, tunny, etc. The symp- 



324 PATHOLOGY AND THERAPEUTICS 

toms of poisoning usually appear in an hour or two after eating them, 
but sometimes in a few minutes after the meal is finished ; a weight at 
the stomach is at first felt, with slight vertigo or headache ; these are 
followed by a sense of heat about the head and eyes, great thirst, and 
an eruption of the skin resembling urticaria, or nettle-rash. 

Treatment. — This has already been given under the head of eryth- 
ema. 

Serpents and Insects. — Those serpents and insects whose bites 
or stings are poisonous, are, the copper-liead, moccasin, viper, black 
viper, water viper, rattlesnake, Spanish or blistering fly, potato fly, 
tarantula, scorpion, hornet, wasp, bee, gnat, and gad-fly. All the 
symptoms are those of violent internal and external erythematic in- 
flammation, and the treatment may bo found also under that head. 



PART VII. 



SURGERY. 

Definitions. — Surgery is either medical, mechanical, or operative. 
According to the old school system, medical surgery comprehends the 
internal administration of drug-remedies, and the external application 
of lotions, liniments, poultices, plasters, etc. In the hydropathic sys- 
tem medical surgery is limited to the internal and external employment 
of water of every temperature, from steam to ice, as the indication is to 
induce relaxation or excite contraction ; the internal administration of 
chemical antidotes or correctives in cases of poisoning, and the local ap- 
plication of astringents, caustics, and emollients, for the purposes of 
constringing bleeding vessels, removing preternatural formations, or de- 
stroying infectious matter, and protecting abraded or ulcerated surfa- 
ces from atmospheric and thermal influences. Mechanical sugery is 
applied to the replacement of displaced parts. Operative surgery con- 
templates the removal of mechanical or chemical obstructions, and mor- 
bid structures. 



CHAPTER I. 

SURGICAL APPLIANCES. 



It has been said that a good workman requires but few tools ; a good 
doctor needs but few medicines, and a good surgeon requires but a very 
small part of the multitudinous instrumental machinery which the in- 
ventive genius and manufacturing interest of the age has brought into 
use. 

The common jacket-case of instruments, with tooth-forceps, liga- 
tures, lint, adhesive plaster, sponge, bandages, male and female cathe< 
28 



826 SURGERY. 



ters, the stomach-pump, and the pump-syringe, are all that emergen- 
cies demand to be kept always in readiness. 

The necessary mechanical, medical, and chemical appliances — re- 
jecting all internal drug-medicines — are, the compress, ligature, sponge, 
adhesive plaster, lints and pledgets, dry-cupping, bandages, spliuts, 
caustics, sutures, torsion, the tourniquet, refrigeration, fomentations, 
emetics, anaesthesia, hcemastasis, and transfusion. 

The Compress. — This is employed to equalize pressure under a 
roller or bandage, or increase the pressure at a particular point. It is 
made of several folds of linen, formed into a kind of pad ; various shapes 
and thicknesses of compresses are employed, to suit the particular local- 
ity and circumstances. For applying around a sore, the perforated 
compress is constructed with a hole in the centre to permit the escape 
of matter. In Water-Cure parlance a wet cloth is often called a com- 
press ; but in the strictly surgical sense, a compress is connected with 
the idea of compression. 

The Ligature. — Various kinds of strings or ligatures are em- 
ployed to arrest the bleeding from wounded or divided blood-vessels, 
check the venous circulation so as to retard or prevent the absorption 
of poison, as in the case of bites of venomous animals, remove tu- 
mors, etc. Silk, linen, and animal membrane — cat-gut — are the ma- 
terials in use. The latter is preferable, especially for tying bleeding 
arteries or veins, as both ends may be cut off close to the wound, and 
the rest left to decomposition and absorption. In applying the ligature 
to wounded vessels, the surgeon's knot — the first knot having two turns 
— must be tied, as this prevents the first knot from slipping while the 
second is being tied. The bleeding vessel should be gently raised with 
the forceps or tenaculum, and the ligature drawn as tightly as may be 
without cutting through the coats of the vessel. Silver wire is some- 
times used in ligating polypus and other tumors. 

The Sponge. — For surgical purposes the finest and softest article 
is the best. It is used to absorb the blood and other fluids from wounds 
and ulcers, and to support temporarily prolapsed parts, as the uterus. 

Adhesive Plaster. — This is employed to retain divided parts in 
proximity; to afford mechanical support to relaxed and distended ves- 
sels, as varicose veins; to excite absorption by compression, as in indo- 
lent ulcers, and protect abraded surfaces. In dressing wounds, it is ap- 
plied in narrow strips, with interspaces for the discharge of matter. For 



SURGICAL APPLIANCES. 827 

small cuts or abrasions, the collodion is the most convenient article, and 
for very small wounds or sores the gummed-silk or court-plaster is suf- 
ficient. Where adhesive plaster is to be applied, the hair should be 
shaved off. 

Tents and Pledgets. — These nre conical or cylindrical masses of 
iharpie, or prepared lint — best made by scraping the fine nap from old 
linen — or sponge, some sizes and forms of which are called meshes, 
rolls, and pledgets. They are employed to keep up a discharge from 
a fistulous or sinuous ulcer, so as to secure granulation from the bottom 
of the sore; to introduce caustics and irritants ; to absorb matter, etc 
Tamj>ons are large tents, for making pressure or applying distention to 
arrest hemorrhage. The sponge-tent is the most convenient when ab- 
sorption is desired ; the common puff-ball, or silk pocket handkerchief, 
are frequently employed in uterine hemorrhages. 

Dry-Cutping. — The application of any convenient vessel, as a com- 
mon tumbler, to the surface, in which a piece of cotton is burned to pro- 
duce a vacuum, is employed to diminish the circulation in the adjacent 
vessels, and to abstract the irritation of an inflamed part, on the princi- 
ple of counter-irritation. This process is preferable to local bleeding — 
wet-cupping — and generally produces momentary relief of pain. But 
I regard it as hardly worth retaining for such purposes, for the reason 
that cold applications to the part, with warm, if need be, at a remote 
part, is a better resource in nearly if not quite all local inflammations. 
Dry-cupping is a valuable resource in reducing inguinal and femoral 
hernia. 

Bandages. — The most common use of bandages is to maintain tho 
fragments or parts of broken bones in juxtaposition during tho healing 
or knitting process; to give support to parts after recent dislocations; 
to promote circulation, and prevent accumulation in chronic swellings of 
the lower extremities, as in oedema, varices, old, deep, indolent ulcers, 
etc. The best are made of firm, smooth, unbleached linen cloth, torn 
into narrow strips, and sewed together by overlapping the ends so as to 
avoid a seam. The bandage must always be smoothly and evenly ap- 
plied, and great care must be exercised to avoid drawing it tighter 
above, or toward the heart, than below, as congestion and swelling will 
result from obstructing the circulation. 

Figure 190 shows the manner of applying the roller to the lower 
extremity. It is about two and a half inches wide ; and, commencing 
at the extremity of the great toe, takes in the second toe at the second 



328 S J 11 E R Y. 



turn, the third toe at the third turn, and so an ; compresses are placed 
in the depressions around the ankle so as to preserve equal pressure , 



Fig. 190. 




APPLICATION OF THE ROLLER. 

each layer overlaps the preceding two thirds or more of its width, and 
the whole is applied smoothly from the toes to the knee. Just above 
the ankle, where the limb is tapering, it has to be folded over itself, 
and its direction frequently changed to preserve its evenness of appli- 
cation. 

Splints. — These are employed in cases of fractures, and sometimes 
to correct deformities. They are made of thin pine or poplar, cedar 
or basswood boards ; or better still, by saturating woolen cloth with 
gum shellac. They must, of course, be shaped to the part to which 
they are intended to be applied, and padded with lint, cotton, or lined 
with soft sheepskin or buckskin. 

Caustics. — The red-hot iron, called the actual cautery, is some- 
times resorted to for the destruction of morbid parts; but more com- 
monly some chemical substance, called the potential cautery, is em- 
ployed. Caustic -potash — potassa fusa — is in general use as a strong, 
and the sesqui-carbonate of potash as a mild caustic. Nitrate of silver — 
lunar caustic — nitric acid, and sulphate of zinc, are frequently em- 
ployed. Preparations of antimony, arsenic, and mercury, are favorite 
eschoratica and caustics with allopathic practitioners, but they have 
already done mischief enough to entitle them to future oblivion. Mild 
caustics will generally remove callous or fungous growths without de- 
stroying the healthy structure ; and the strong is necessary when the 
healthy parts are so involved with the disease that some portion of 
sound structure must be sacrificed to get rid of the morbid. Fortu- 
nately this necessity is of rare occmrence. 



SURGICAL APPLIANCES. 



829 



Sutures. — Stitching divided parts together is much less practiced 
now than formerly — superior skill in the management of bandages and 
adhesive straps having superseded, in a great measure, its necessity. 
Sutures are mostly employed to restrain the mobility of parts, and 
prevent permanent contraction of the muscles, in situations where 
straps and bandages cannot be well applied. The curved needle should 
always be passed from within the wound outward, and take up but 
little more than the skin. The twisted suture is employed for the 
double purpose of adaptation and compression. After 
the needle or pin has transfixed the lips of the 
wound, the thread is applied in successive coils round 
under the point and head, as in fig. 191. The inter- 
rupted suture is made by passing the threaded needle 
through the edges of the wound, at short distances, 
and then removing the needle and tying the thread. 
In the dry suture the needle is passed through 
strong bands of adhesive plaster, which are placed 
above and below the wound. twisted suture. 




Torsion. — This process 
merely consists in getting 
hold of the extremity of the 
bleeding vessels with a pair 
of forceps, and twisting them. 
It stops the bleeding of small 
arteries, and is so far a sub- 
stitute for tying. 

The Tourniquet. — This 
instrument is a form of liga- 
ture, and is calculated to 
compress large and deep- 
seated arteries in amputations 
and other exigencies. The 
pad or compress is applied 
directly upon the artery 
above the injury or operation, 
and pressed upon the vesse 
until the pulsation of the 
artery beyond is suppressed, 
by turning the screw. A 



Fig. 192. 




Tin: tourniquet. 



930 



SURGERY. 



good substitute for the common tourniquet may be made in a moment 



Fig. 193. 




HANDKERCHIEF LIGATURE. 

which the knot is applied, as in fig. 193 



in various ways. A 
handkerchief, tied 

twice around the 

-\ limb, may be twisted 

\\^D with a stick until 

^ the pressure stops 

the current of blood 

in the artery against 



Congelation. — In deep-seated chronic inflammations, especially 
around the joints, absolutely freezing the part, by means of pounded 
ice «• refrigerating mixtures, has been attended with the happiest con- 
sequences; the application should never be continued but for a few 
minutes at a time. It is also one of the means for restraining hemor- 
rhage. Severe cold has been employed to remove the sensibility, pre- 
paratory to surgical operations ; and the testimony is unanimous that, 
in every instance "the wound has appeared to heal more speedily 
than under the usual circumstances." Dr. Arnott has used frigorific 
mixtures as anaesthetic agents in nearly two hundred cases without 
any injurious consequences; and he reports that foul ulcers are often 
changed to healthy ones by their action. A piece of ice dipped in 
salt, and applied to the part, produces congelation in about half a 
minute. Pieces of ice mixed with common salt and nitrate of ammo- 
nia, make a still stronger frigorific. It should never be applied to a 
very large surface at once. 



Fomentations. — These are intended to abate morbid sensibility, 
and relax the whole or part of the muscular system, to overcome 
spasms, and facilitate the replacement of luxated joints, fractured 
bones, ruptures, etc. All the muscular relaxation which regular sur- 
geons endeavor to produce by profuse bleedings and deathly nauseants, 
can be readily and harmlessly produced by the internal and external 
use of warm water. 

Emetics. — In many cases of rigid muscular contraction, to facilitate 
the reduction of a dislocation or the replacement of the fragments of 
fractured bones, powerful and injurious doses of tobacco or tartar 
emetic are administered to induce greater relaxation; or the patient is 
kept for a long time in a stRte of excessive nausea. Warm water, 
taken copiously into the stomach, assisted by tickling the throat occa- 



SURGICAL APPLIANCES. 331 

sionally, will answer all the purposes for which so manydeathful drugs 
are employed, especially if conjoined with external fomentations or 
the warm-bath. 

Anesthesia. — Chloroform and ether are just now in common use 
to produce insensibility, and thus obviate the pain attending surgical 
operations; and many surgeon accouchers administer chloroform to 
lessen or obviate the pain in nearly all cases of parturition. They are 
not without danger, and the introduction of these agents into ordinary 
obstetric practice is to be reprobated. When an operation is exceed- 
ingly dangerous, painful, or protracted, the employment of anaesthetic 
agents is certainly commendable; and, although we have accounts of 
some thirty deaths occurring from their direct effects since their intro- 
duction into surgical practice, yet I suspect that some of those deaths 
at least, were attributable to a want of the proper precautions, or rather 
an ignorance of the proper precautions on the part of the operator. 
The same rules should be observed in administering chloroform or 
ether, as are enjoined by hydiopaths in administering a full-bath. The 
stomach should be empty ; the patient in his ordinarily quiet or com- 
posed state; that is, without rush of blood to the head, or determina- 
tion to the brain ; the extremities must be warm, and a general glow 
upon the surface, etc. The ether is the safer article, but the chloro- 
form is the most powerful. In many cases magnetism will produce 
the desired insensibility, and when the patient is susceptible, this pro- 
cess is always to be preferred. 

Hemastasis. — This process has been employed in the treatment 
of local congestion and inflammation ; but we have, in water of various 
temperatures, an ample and a better resource. It is a valuable expe- 
dient, however, in some cases of sudden and alarming hemorrhage, as 
it enables us to retain a greater proportion of blood within the body, 
and also to lessen its impetus at the bleeding point, thereby favoring 
the formation of a clot or coagulum. Dry-cupping an entire limb, for 
which purpose elongated cylinders of flexible material have been in- 
vented, is one method of holding back its blood. The common ligature 
round the limb is equally efficacious. 

Transfusion. — In some cases of excessive loss of blood, life has 
been preserved by opening the vein of a healthy person, or of a sheep, 
and transferring the blood immediately into the vein of the bleeding 
patient, a suitable vessel or funnel being connected with the latter for, 
the purpose of receiving it. 



839 SURGERY. 



CHAPTER II. 



Distinctions of Wounds. — The usual division of wounds is into 
incised, punctured, penetrating, contused, lacerated, gunshot, and 
poisoned. An incised wound is a simple cut, made, of course, by a 
sharp-edged instrument, as a knife, razor, axe. A punctured wound 
is made by a sharp-pointed instrument, as a needle, awl. A penetrating 
wound is a larger puncture, as by a bayonet. A contused wound is 
occasioned by a blunt instrument, as a stone, club, which injures the 
parts below the surface, the skin remaining entire. A lacerated 
wound is inflicted by an instrument which is both blunt and rough, and 
which tears the integument as well as injures the parts beneath it. 
Gunshot wounds include all injuries accruing from substances impelled 
by the explosive force of gunpowder, as leaden bullets, cannon balls, 
stones, etc. They partake of the character of both punctured and 
lacerated wounds. Poisoned wounds are the injuries inflicted by in- 
sects, reptiles, rabid dogs, etc., whose stings or bites are accompanied 
with the introduction of a specific virus. 

General Consequences of Wounds. — Bleeding is the only 
alarming symptom in incised wounds, which can generally be healed by 
the "first intention," that is, without suppurating. All the other 
varieties are attended, save when very large arteries are torn, with 
but little hemorrhage, but always supipurate more or less. In gunshot 
wounds, the concussion of the air impelled by the ball often inflicts 
severe injury, without making any mark upon the skin. In most 
wounds there is more or less extravasation, or an infiltration of blood 
into the cellular membrane. The pain is generally in the inverse ratio 
to the danger, for the reason that the more destructive the injury, the 
less power has nature to give the alarm. The danger of wounds, other 
circumstances being equal, depends on the actual health, or physiolog- 
ical state of the system at the time the wound is received. The most 
trivial scratch, or the simplest cut, has been followed by bad sores, loss 
of limb, and even life, in persons of extremely morbid blood, foul se- 
cretions, and reduced vitality; while those of sound, pure bodies, re- 
cover from the most complicated injuries with comparatively little dif- 



WOUNDS. 



883 



ficulty. Spirit-drinkers and beer-bibbers are notoriously liable to ex- 
treme inflammation, foul ulcers, mortification, etc., from injuries which 
water-drinkers might regard as trifles. 



Treatment of Wounds. — The first point, in all cases, is to control 
the hemorrhage. Arterial bleeding, which is always far the most 
dangerous, may be known by the bright scarlet color of the blood, and 
its issuing in jets. It may be stated as a general rule, probably an in- 
variable one, that all hemorrhage from blood-vessels below the wrist 
and ankle, can be arrested without ligating the arteries. The injured 
part should be freely exposed to the cold air, and washed in the coldest 
water. In many cases the bleeding from small vessels is kept up by the 
dressings — covering the wound with compresses, lint, etc., which keep 
up the heat, and prevent the formation of a coagulum. I have known a 
deep wound in the thigh, made by a piece of glass, bleed for several days 
in spite of lint, and sutures, and bandages, and cease entirely on being laid 
open with a scalpel with a view of tying the wounded artery, which, by 
the way, was not found. In some cases the wounded artery can be com- 
pressed by the finger, as the radial artery in fig. 194. If the pressure 



Fig. 194. 



must necessarily be kept up a long 

time, a piece of soft rag several 

times folded may be placed over 

the aperture, and secured by a 

piece of broad tape, bandage, or 

pocket handkerchief, as in fig. 195. 

When internal bleeding occurs, 

known by paleness, faintness, etc 

sips of the coldest water or bits of 

ice should be frequently swallowed* 

and absolute quiet enjoined. Bleed- compressing the radial artery. 

ing from large arteries must be controlled by the tourniquet, and the 

artery ligated. When the bleeding is from the upper extremity, the 




Fig. 195. 



brachial artery must be com 
pressed above the middle of 
the arm; and if from the 
lower, the femoral artery 
should be compressed just 
below Poupart's ligament. 

The congestion and in- 
flammation which may attend all wounds merely require frequent 
changes of the water-dressings ; and when the inflammation of a 
wound has extended to the neighboring glands, producing painful 




THE COMMON COMPRESS. 



334 S U R G E R Y. 



swellings, these should be kept well covered with several thicknesses 
of wet cloths. 

The lodgment of foreign substances in wounds is to be ascertained 
by introducing the finger or a probe, and extracted if possible ; not, 
however, until all danger from hemorrhage is past; and when poison- 
ous substances are imbedded in the fl'esh, warm water or neutralizing 
solutions should be frequently injected. 

In suppurating wounds the edges must be kept apart, to allow free 
egress to all matter that may form within ; and if the granulations, in 
the healing process, arise above the surface, and become loose and 
flabby, constituting/ufljg-ews or proud flesh, straps of adhesive plaster or 
collodion should be applied to act as a compress. In bad cases caustic 
potash may be necessary. 

Secondary ]iemorrhage is liable to occur in lacerated wounds from 
the sloughing of large arteries ; and in bad cases, gangrene. They 
require the coldest water-dressings. The moderate douche is excel- 
lent in contused wounds ; and when they become irritable and painful 
the part may be bathed in warm water, followed by the cold compress. 
Tlie absorption of extravasated blood may be promoted by the cold 
streams and cold wet compress. 

The general treatment of poisoned wounds has been detailed in the 
preceding part of this work. 



CHAPTER III. 



Concussion. — A stunning, or concussion of the brain, is the result 
of blows upon the head, or of falls, which so shock the whole system as 
to occasion a temporary suspension of consciousness. The extent of 
the injury cannot be known, nor is it material that it should be until 
the patient " comes to." It may be so severe as to produce instan- 
taneous death ; or so slight as to leave no apparent ill consequences. 

Treatment. — Perfect quiet, and a careful attention to keep up the 
general circulation and normal temperature, are the principal remedial 
resources. The extremities must be kept warm, cold cloths should be 
laid over the head, and if the concussion is prolonged, the bowels may 
need evacuating by means of injections, and the urine require to be 
drawn oft" by the catheter. 



N JURIES. 



The old practice of bleeding, which I :un sorry to know is also a 
common practice with modern allopaths, has no better effect than to 
lessen the patient's chance of recovery. Indeed, this has been the 
opinion of some of the best European surgeons for the last fifty years, 
and a majority of all modern authorities is against the practice ; bo 
sides, it is in itself at variance with common sense; yet our doctors con^ 
tinue the killing practice of letting blood as though there was some sci- 
entilic reason for it ! 

Compression. — This is usually the result of concussion, and its im 
mediate cause is an extravasation of blood within the cranium; or some 
collection of other matter; or mechanical pressure from a depressed or 
broken part of the skull bones. It is denoted by continued pain in tho 
injured part of the brain, with cerebral disturbance; or, in the absenco 
of these, frequent faintings, spasms, disordered vision or hearing, with 
nausea and vomiting. The patient is often also comatose. 

Treatment— -When a portion of the cranium is depressed it must be 
raised by a lever ; or if this is impracticable, the operation of trephi 
ning will become necessary. The head should in all cases be kept 
thoroughly cooled with wet cloths or the pouring-bath, and derivative 
treatment, especially tepid, hip, and foot-baths should be frequently 
employed, caution being taken to secure prompt reaction. In ex- 
treme cases, hot foot and leg-baths are useful, especially when the pa- 
tient is affected with delirium or coma. In young persons very bad 
fractures of the cranial bones will often replace themselves if the gen- 
eral health is well attended to. 

Bruises. — These are only worth naming for the purpose of men- 
tioning that *he cold douche, and the wet compress, are worth more 
than all the stimulating liniments and embrocations in the world, in 
their treatment. 

Strains. — These accidents usually happen to the smaller joints, as 
the wrist, fingers, ankle, and toes; they are generally exquisitely pain- 
ful, and are very liable to be followed by painful and protracted inflam- 
mation. The part should be held in cold water, or the cold stream 
applied to it until the violence of the pain abates, and then wrapped 
in wet compresses until all inflammatory excitement is passed. 

Burns and Scalds. — Burns are produced by the action of concen- 
trated heat upon the living tissue. Scalds are produced by the appli- 
cation of a boiling or hot fluid. The danger of these injuries is usually 



830 



SURGERY. 



measured by the extent of surface destroyed. Authors make three, 
four, five, and sometimes six degrees of burns; but the smallest num- 
ber is sufficient for all practical purposes. The first is rubefaction, or 
redness ; the second, vesication, or blistering ; and the third, disorgan- 
ization, in which the skin is destroyed, and perhaps some structures 
beneath the skin. The paiu is usually the severest in the second va- 
riety. Superficial burns or scalds are easily healed when not mal- 
treated ; but deep burns, as by a hot iron, usually leave an ugly scar. 
Many terrible burns are frequently taking plaeo by the clothes of 
women, children, and servants taking fire from carelessness in hand- 
ling camphene, burning fluid, tea-kettles, coffee-pots, etc. 

Treatment. — When one's clothing is on fire, the first thing to be 
done is to extinguish the flame ; and as the sufferer might burn to death 
before a supply of water could be obtained, the flame should be suffo- 
cated by covering the patient with a blanket, carpet, or some similar 



Fig. 196. 




article, as represented in fig. 196. The next point of treatment is to 
immerse the injured part in water, or cover it with wet cloths of the 
temperature which feels most agreeable to the patient. The coldest 
water will prove the most soothing at first ; and in a longer or shorter 
time, according to the severity of the inflammation, tepid water will be 
found most sedative ; and finally warm water will often feel tho best. 
But the rule is invariable : follow the sensations of the patient. When 
the skin is vesicated, it should be kept covered with soft linen. The 
blisters which form should not be punctured or torn until suppuration 
has taken place on the surface, as they form the best protection to the 
injured surface. 

As the contact of the atmosphere, or rather of a colder medium is 
excessively painful to the raw surface after the skin or cuticle comes 
off, the rooir should be kept quite warm, and nil applications should 



INJURIES, 837 

then be moderately warm. The best covering in this condition is 
simple flour, dredged over the surface, allowed to remain until it 
becomes loose by the purulent matter beneath, then removed, the 
surface gently washed with warm water, and more flour applied. A 
soft cloth may be placed over the flour and kept continually wet with 
water ; and the flour-dressing may be continued until cicatrization is 
completed. I have seen very bad burns heal rapidly and admirably 
'jnder this management : starch, and finely- pulverized slippery elm 
*jark — elm flour — are favorite applications with some practitioners, but 
I know not that they have any advantage over the common flour. 

There is always a considerable degree of constitutional disturbance 
after a severe burn, as rigors, oppressed respiration, small, weak pulse, 
followed by more or less febrile reaction. Thi« requires warm hi? *nd 
foot-baths, when practicable, during the period of chilliness, and tepid 
ablutions during the febrile stage ; the room should always be kept con- 
siderably warmer than in cases of the same violence of fever from any 
other causa. 

The allopathic treatment of burns and scalds is a singular jumble of 
the " good, bad, and indifferent." Professor Parker, of this city, after 
telling us that "the treatment of scalds and burns suems to us to be 
eminently empirical in all our systematic works on surgery," gives us a 
rational basis of treatment. This is "the use of such agents as are 
calculated to meet the existing debility." "The most prominent of the 
local and constitutional symptoms is great nervous prostration ." On this 
basis the professor recommends warm brandy and tincture of opium to 
get up reaction ; and then antimony, Dover's powder, calomel, and ipe- 
cacuanha, to get the .reaction down again ; or, in his language, " regu- 
late the reaction, that it may not run too high." " General bleeding," 
he continues, " is commonly indicated by the great tendency in such 
cases to a typhoid condition of the system." Bleeding indicated be- 
cause the nervous system is prostrated, and the whole system in a sink- 
ing condition ! Is not this pre-eminently empirical ? 

Among the sequelae of burns and scalds, are contractions of the skin 
and adhesions around the tendons, producing distortions and deformi- 
ties. These must be prevented, as far as possible, by maintaining the 
normal position of the parts during the healing process. Dr. Parker 
remarks: "When these scalds and burns are upon the trunk, and 
there has been a copious suppuration, unless we are guarded in our 
treatment, as cicatrization takes place and the secretion is diminishing, 
there will occur suddenly and unexpectedly, effusion upon the brain or 
lungs, and death." The way to "guard" against such disastrous re- 
sults is, by avoiding the drugging and bleeding part of the treatment. 
II— 23 



338 SURGERY. 



Particular Wounds and Injuries.— Venesection— phlebotomy— 
is a wouud made by puncturing a blood-vessel with llie point of a lai*- 
cet, a ligature having been previously applied between the contem- 
plated wound and the heart. Some one of the veins or the inner 
aide of the fore-arm, near the elbow, is usually selected ; but occasion- 
ally the external jugular vein, the veins of the fool, and the temporal 
artery are opened. The consequences of this operation are, 1. Loss 
'of blood, which is irremediable. 2. E-ccliymosis — a livid, hard tumor, 
occasioned by an extravasation of blood into the cellular membrane, in 
consequence of the wound in the vein not exactly corresponding with 
that in the skin ; it requires the cold douche and cold compresses. 3. 
Aneurism — an arterial swelling, produced by pricking through the vein 
into the adjacent artery, or missing the vein with the point of the lan- 
cet and hitting the artery ; this requires the operation of ligating the 
artery above the injury. 4. Lock-jaw — prod need by pricking or di- 
viding some nerve in the vicinity of the venesected vein ; it requires the 
treatment heretofore mentioned under the head of Spasmodic Diseases. 
5. Phlebitis — inflammation of the veins of the wounded part, of which 
the operation is the exciting cause ; this requires the wet-sheet pack, 
with wet cloths to the inflamed part. 6. Fainting — which results from 
the abstraction of a large quantity of blood, or from a less quantity sud- 
denly withdrawn by making a large orifice ; the treatment has been 
described under the head of Syncope. 

Leeching and scarifying are among the common injuries which 
modern surgeons are fond of inflicting upon afflicted humanity. The 
usual morbid consequences are, inflammation of the skin and adjacenS 
blood-vessels — erythema and phlebitis — dangerous hemorrhages, and un- 
seemly scars. For all these " accidents," the coldest water is the best 
remedy. 

Wounds of the throat, of which throat-cutting is the most prominent 
example, present many degrees of severity and danger, from a mere 
incision through the integument, to a division of the jugular veins, wind- 
pipe, and carotid arteries. The principal danger is from hemorrhage ; 
and all the vessels which bleed freely, whether arteries or veins, must 
be taken up and tied ; after which the lips of the wound are to be re- 
tained together with both sutures and adhesive straps. 

Wounds of the scalp are liable to be followed by erysipelatous in- 
flammation ; the hair must be shorn, and the divided parts brought in 
proximity by adhesive straps, and sutures when necessary. 

Wounds of the chest are apt to penetrate the substance of the lungs, 
in which case air and blood together will bubble oat of the wound, 
and the patient will manifest short breath and blooiy expectoration 



IN J UK IBS. 



The wound should ho covered with a plaster, and cooling derivative 
baths — half and hip — employed. 

Dr. Hill, author of an excellent surgical work (Eclectic Surgery), 
makes the following pertinent remarks in relation to the bleeding prac- 
tice in this case. "Venesection is recommended in tho books 'to di- 
rect,' as they say, ' the blood from the luugs.' But surely it is as well 
to bleed to death through a wound in the chest as through one in the 
arm! We are told that the bleeding 'can hardly be carried too far; 
for if the patient be not relieved by this measure, no other can possibly 
save him.'' (Gibson, vol. i., p. 19.) The reason given for bleeding, in 
such cases, is as absurd as the process itself." 

Wounds of the abdomen are among the most dangerous. When the 
intestines are wounded, the patient is affected with nausea and vomit- 
ing, and the matters ejected or dejected will be bloody. When a por- 
tion of intestine protrudes, it must be replaced as soon as possible; if 
this is not done within forty-eight hours, adhesions may form and ren- 
der it impossible. When the protruded bowel is distended with gases 
or fasces, by which its return is hindered, these may bo pressed for- 
ward into a portion of intestine within the abdominal cavity; or, if this 
measure fails, the wound must be dilated. These wounds, when large, 
may require the suture ; a fine needle and thread only should be used. 
For several days after severe injuries of the bowels or lungs, the pa- 
tient should eat little or nothing, and the bowels be moved, when neces- 
sary, by warm injections. 

Wounds of the joints are liable to be followed by severe inflammation, 
terminating in adhesions and anchylosis, or stiff-joint. The limb should 
be kept in the easiest possible position, perfect quiet observed, and cold- 
water dressings be assiduously applied. The modern disease, called in 
some late books synovitis, is a chronic inflammation of the synovial 
membrane, and to some extent of other structures of the joint, and is 
produced by some external injury. I have seen several cases affecting 
the knee-joint, produced, most unquestionably, by wearing strapped 
pantaloons. Synovitis is known by a sense of weakness or lameness in 
the affected joint, always increased by any considerable motion, and 
frequentby amounting to pain when the exercise is prolonged. There 
is usually none, or but slight, external redness, swelling, or heat. This 
affection requires a long time to cure ; the remedial plan consists of a 
very strict dietetic regimen, one or two general baths daily, with the 
constant application of local compresses, and occasional shallow foot- 
baths. When the knee-joint is the seat of the disease, the cold leg- 
bath should be employed for half an hour once or twice a day 



840 SURGERY. 



CHAPTER IV 



Every tumor is a morbid swelling or a new formation — an increased 
or perverted development of organic substance. The common causes 
are injuries, as pressure, blows, bruises, etc., although it is seldom that 
we can trace any particular tumor to the particular accident from which 
it originated. They may also arise from capillary obstruction, and this 
is induced by many of the unhealthful eating, drinking, and anti-bath- 
ing habits of society. A mechanical injury of the vessels of a part, or 
a long-continued inflammation or obstruction, may produce a change in 
its nutritive function, by which an abnormal structure is developed ; 
and when once this perverted actiou commences, it may progress to an 
indefinite period or extent. In their incipient stages they can frequently 
be removed by strong douches, cold compresses, and continued com- 
pression. Tumors are distinguished into ad iposc, cellular, fibrous, carti- 
laginous, osseous, encysted, fungous, indurated, scrofulous, malignant, 
jjulsating, vascular, etc., according to the structure affected, and the 
form, character, and consistence of the swelling. 

The older surgeons divided tumors into sarcomatous or fleshy — com- 
prehending those which are composed of fatty, fibrous, medullary, 
fungous, or other substances softer than bone ; osseous or bony ; osteo- 
sarcomalous — when involving both the bony and fleshy structures ; and 
encysted — containing a fatty or fluid substance within a globular cyst, as 
in the case of ivens and hydatids. 

Adipose tumors are collections of fatty matter inclosed in a cyst or 
sac of condensed cellular membrane, which renders them also encysted 
tumors. When filled with a suet-like matter, they are called stcato- 
mous ; when containing a honey-like substance, melicerous ; and when 
their contents are a pap-like fluid, atheromatous They are not pain- 
ful, and only inconvenience the patient by their bulk, weight, or pres- 
sure. They are easily removed by making a T incision through the 
skin, and carefully dissecting around them to detach the cysts from the 
surrounding structures. They may be removed by the " eight-tailed 
ligature," fig. 197, two needles being drawn through the under side 
of the tumor, touching each other at right angles, and each carrying 
a double ligature; the loops are then cut, and the ends tied in four 
knots, by which the tumor is completely strangulated. These tumors 
do not reappear after having been entirely removed. 



TUMORS. 



841 



Fig. i97. 




LIGATURE FOR TUMORS 



Fibrous tumors are 
composed of capsules of 
greater or less densi- 
ty, inclosing yellow or 
wbitis-h substances di- 
vided into lobes or septa 
by cellular substance ; 
their shape is irregular, 
and they have a doughy 
consistence. They are 
not painful, and are easi- 
ly removed by the liga- 
ture or knife, being al- 
most always situated in 
accessible places. The 
fibrinous contents of these tumors adhere so loosely to their capsules 
that they can readily be removed by the finger or forceps on making 
an incision through the skin. 

Cellular tumors are smooth, firm, and composed of compacted layers 
of areolar tissue, containing, in thin cells, albuminous, fibrinous, and se- 
baceous matter. They are never painful except when inflamed. The 
cutaneous veins involved in the tumors may become varicose, and when 
abrasion occurs, sloughing and fungous growths are apt to follow. Ex- 
cision with the knife is the best treatment ; but when sloughing takes 
place the mild caustic is necessary ; and the strong caustic when fun- 
gous appearances present. 

Vascular tumors are limited, in surgical technology, to those morbid 
developments of erectile tissue called ruevi materni, or aneurism by 
anastomosis ; and these may be superficial or subcutaneous. The 
proper plan of treatment contemplates the destruction of the morbid 
congeries of blood-vessels in such a manner as to avoid hemorrhage. 
Repeatedly puncturing the part with hot needles, and the repeated ap- 
plications of caustic, a small part of the surface only being touched at 
once, with constant but moderate compression, have each succeeded in 
removing them. 

The character of the other varieties is sufficiently indicated by their 
name, and the treatment will be given under the head of particular 
tumors. 

Whelk — Iont'hus. — This affection is a stationary, tubercular, un- 
suppurative tumor, generally found upon the face. It comprises the 
varieties called stone pock, and carbuncled fafe, or rosy drop — gulta 



842 SURGERY. 



rosea. Stone pock is a pimply eruption of hard, red tumors, which are 
sore to the touch, and ooze a little fluid at the tip, or a grub-like con- 
cretion of mucus. In the carbuncular variety the tumors are confluent, 
and mottled with purple, often disfiguring the nose with pendulous 
lobes, and marring the face, as Shakspeare has it, with " bubukles, and 
whelks, and knobs, and flames of fire." In Ireland, the common name 
for these protuberances is grog-blosso7iis ; in this country they are 
known as rum-blossoms, grog-roses, cider-buds, beer-berries, etc., while 
their possessors are honored with the appellation of copper-noses, bot- 
tle-noses, etc. 

Special Causes. — Grease-eating and "hard drinking." 
Treatment. — Few invalids, distinguished by the carbuncular variety 
of the whelky tumor, can be expected to submit to ivater-trentmexit ; 
and, moreover, these patients have the same reason to regard their 
" roses" and " blossoms" as badges of honorable distinction, that the 
Englishman has his gouty toes and stomach, or the Polynesian Islander 
his enormously misshapen leg. All alike can boast of " high living." 
But if we should be called upon to indicate a remedy, we might with 
all propriety suggest the details of a " sober and temperate life." 

Sycosis. — This term has been applied to a fig-shaped tumor, a fun- 
gous ulcer, and a horny excrescence about the eyelids ; but usually and 
here it is employed to denote an eruption of inflamed tubercles on the 
scalp, and on the bearded portion of the face. These tumors often ul- 
cerate and discharge an ichorous or glutinous matter. They are con- 
nected with uncleanliness in either the positive or negative sense — bad 
diet or drink, or the absence of watec, and may be cured by thorough 
local and general bathing. 

Warts — Veruccs:. — These are rather excrescences than tumors ; 
some are smooth and apparently filled with fatty matter ; others, called 
seed-warts, are rough, hard, and insensible. Some warts secrete a 
fluid which is infectious, and will produce a crop on other persons or 
on other parts of the same person. They may be effectually removed 
by caustics — potassa, nitrate of silver, nitric acid, or nitro-muriatic acid. 
The latter preparation is the best ; it may be applied by means of a 
pointed piece of wood to the centre, taking care not to let the acid 
come in contact with the surrounding structure. To prevent this, a 
piece of perforated adhesive or court-plaster may be placed around the 
wart. The acid may be repeated until the troublesome and unsightly 
excrescence is entirely destroyed, which will usually require but a 
few days. 



TUMORS. til 



Corns — Clavi. — These well-known toe-tormentors are produced 
by tight shoes or boots. The first principle of cure is to give the feet 
a respectable area of freedom ; and the second is to soak them in warm 
water, and shave off the horny substance, and then touch them with 
the nitric or nitre-muriatic acid. When the corn is inflamed or highly 
irritable, the tepid foot-bath should be employed to remove this condi- 
tion before the acid is applied. The aqua regia — nitro-muriatic acid 
— is the ordinary secret remedy of the " corn-curers." When the 
corn is fully formed, or ripe, a membrane separates it from the true 
skin, so that it can be taken off without injuring that surface ; and this 
circumstance enables professional chiropodists to elevate the " grain" 
on the point of a pen-knife, after an application of the acid. 

Bunion. — This affection, though generally regarded as a variety of 
corn, is really an inflammation and swelling of the bursa mucosa, at the 
inside of the boll of the great toe ; it often produces a distortion of the 
metatarsal joint of the great toe, and is produced by the same causes as 
corns. The treatment is, warm foot-baths, when the part is very ten- 
der and irritable ; at other times, frequent cold-baths ; and when a 
horny substance resembling a corn appears externally, the application 
of caustic. I have known bad corns and bunions cease to foe trouble- 
some after the patient had been a few months under hydropathic treat- 
ment for other complaints. 

Ontxis. — This distressing affection, sometimes known by the dis- 
tressing synonym of onychogrypkosis, consists m an incurvation of the 
toe nail from a bruise or the pressure of a tight shoe, producing in- 
flammation and ulceration, and followed eventually by fungous growths, 
or proud flesh, which is exceedingly tender and painful. The cure is 
slow but certain. The foot must be frequently soaked in warm water 
until the soreness is so far abated that it can be handled without pain; 
then with a probe press pledgets of lint as firmly as can be borne under 
the most detached point of the toe nail, pressing them also between the 
nail and projecting portions of the flesh as far as possible. Cover these 
with the wet compress, and apply a moderately-tight bandage over the 
whole, frequently wetting the whole with warm, tepid, or cool water, 
as either temperature is most agreeable. The tents are to be pressed 
further and further under the nail from time to time, and the foot 
should be soaked and dressed once or twice daily. When poitions of 
the nail become free they may be cut oft", and mild caustics may be 
employed to remove fungous or indurated growths, which do not yield 
to the other measures of treatment. 



844 SURGERY. 

Gan«I.ioks.— These are encysted tumors, formed of a viscid, albu- 
rainona fluid, resembling the white of an egg, and varying in size from 
a pea to that of an egg. They are hard, globular, and without discol- 
oration of the skin. Sometimes the cyst is loose, but in most cases it 
communicates by a narrow foot-stalk, with the sheath of a tendon, or 
the synovial capsule of a neighboring articulation. Ganglions are al- 
ways situated in the course of a tendon, and usually appear on the 
wrist, hand, and top of the foot. In their treatment surgeons have re- 
sorted to compression, percussion, discutient applications, extirpation, 
and caustics. When the tumor is prominent and round, a simple in- 
cision will allow its contents to escape, and if dressed with a moderate- 
ly tight compress, the wound will heal readily. I have always re- 
moved them in this way. and never knew any injurious consequences 
to result, from the operation. Oblong and diffused ganglions may be 
punctured with a lancet or couching needle, and the fluid pressed oat. 
When the cyst :s thin it may be ruptured by a blow or by pressing it 
firmly against the bone — in which event the fluid will be absorbed and 
a cure result ; but whether the sac can be ruptured with a safe degree 
of violence, eau only be known by trial. Irritants or caustics, to ex- 
cite suppuration, is a method recommended by some authors ; it is 
applicable to cases attended with ulceration or induration. 

RANtTKft. — This is a small tumor under the tongue, resulting from 
obstruction of some one or more of the excretory ducts of the sub- 
maxillary or sublingual glands. It may be cured by clipping off a 
small portion with a pair of sharp scissors ; and, if it does not disap- 
pear in a few days, touch it with nitrate of silver or sesnui-earbonate 
of potash. 

Epuijs. — A small tubercle of the gums, which generally appears 
above or below the incisor teeth, sometimes becomes a serious malady. 
It commences with a small seed-like swelling, which grows so slowly 
and painlessly as to attract little notice ; but at length it enlarges rapidly, 
becomes soft, bleeds on the slightest touch, fungous formations spread 
out, involving the gunu displacing the teeth, and affecting the glands 
of the mouth and otho ' soft parts, until the patient is destroyed by 
hemorrhage or worn out with irritation. The best surgeons recom- 
mend the removal of the tumor as soon as its diameter is ascertained. 
The adjoining teeth must bo first extracted. Sir Asttey Cooper pre- 
fers the knife : but the cauterizing process as recommended by Dr. 
Hill is, I think, far preferable; it consists in destroying the tumor to 
'ts base, with every portion of the diseased structure, by means of 



TUMORS. 345 



caustic potash, applied until disorganization and sloughing take place — 
the surrounding parts, lips, tongue, etc., being protected by cotton wet 
in vinegar, rolled up and pressed in around the portion to be cauterized. 
In all cases of malignant tumors and ulcers, let me here say once for 
all, a rigid!}' abstemious and exclusively vegetable diet is one of the 
most important, and frequently one of the indispensable measures of 
the remedial course. 

Bronchocelk. — This tumor, commonly called goitre, or swelled 
neck, is a preternatural enlargement or hypertrophy of the thyroid 
gland. In its early stage it is soft and elastic ; but as it advances in 
size it becomes firmer, and spreads toward the sides of the neck, at- 
taining sometimes a prodigious magnitude. In the valleys of Switzer- 
land, Savoy, the Tyrol, Derbyshire, and some other places, it is very 
prevalent ; most frequently, however, affecting young females. It is 
found in all parts of the United States, but more commonly in low, 
moist, marshy, or malarious situations. In this country the disease 
seldom increases to a dangerous extent, the deformity being the prin- 
cipal source of uneasiness. 

To treat this complaint successfully we must employ as powerful 
douches to the spine and to the tumor itself as the patient can conve- 
niently bear, with occasional packings in the wet-sheet, and a thorough 
course of derivative half, hip and foot-baths; and to this course of bath- 
ing must be added a plain, abstemious, and rather dry diet. The 
drop-bath for half an hour or longer, followed by the wet compress, is 
among the promising remedial resources ; and if there is the least ten- 
dency to constipation, tepid injections should be freely employed. 

It is but a few years since iodine was the vaunted specific for this 
disease throughout the medical world ; but it was found at length that 
a great many more constitutions were killed than bronchoceles were 
cured by the remedy ; hence, like every other specific which ever has 
or ever will be got up on drug-medication principles, its destiny is — 
oblivion. 

Paronychia — Whitlow — Felon. — An acutely painful inflamma- 
tion, seated about the nails and ends of the fingers, has been called by 
these terms indiscriminately ; the term paronychia is applied to all 
phlegmonous tumors of the fingers and toes. In some cases the in- 
flammation commences ra the periosteum, and effusion takes place be- 
tween if, and the bone, constituting the worst or malignant form — the 
true felon ; in the tendinous whitlow the inflammation commences in 
the sheath of a tenr'on; and in a variet}- called cutaneous, t'ze effusion 




ARM-BATH IN WHITLOW. 



846 3UR JERY. 

occurs in the subcutaneous areolar tissue, or between the skin and epi- 
dermis. Similar inflammations are sometimes found about the palms 
of the hands and soles of the feet. 

The severe and lancinating pain of paronychia! tumors arises from 
the firmness and inelasticity of the skin and other structures where it is 
seated, which act upon the inflamed vessels like a tight bandage, pro- 
ducing a most distressing sense of pressure ; and hence it is that when 
the skin opens the soft parts below are pushed out like a fungus, and 
become exquisitely tender. 

Treatment. — On its first appearance this affection may generally 
Fig. 198. De promptly cured by immersing 

the whole arm in very cold water . 
The arm-bath, fig. 198, sliould be 
frequent and prolonged. When 
discoloration of the skin indicates 
approaching suppuration, tepid, 
or even warm water to the in- 
flamed p<frt, with the cold elbow- 
bath, will prove the most soothing 
treatment. In the felonious variety it will save the patient much time 
and suffering to cut with a scalpel down upon the bone, making a free 
incision one or two inches in length. 

Scirrhus and Cancer. — I have already treated of cancers medi- 
cally, but as many surgeons regard scirrhus and cancerous tumors as 
distinct diseases, while others treat of scirrhus as though it were the 
first stage or beginning of a cancer, it may be proper to consider both 
subjects connectedly in this place. 

It is unquestionably true that all cancers are in their incipient stage 
hard, scirrhous, indurated tumors — occult cancers — and in their latter 
stage, open ulcers — carcinoma. But it is equally true that indurated or 
scirrhus tumors often remain for an indefinite period in a condition of 
cartilaginous and almost stony hardness, without evincing any tendency 
to cancerous ulceration; and not unfiequently, when irritated or in- 
jured, degenerating into other malignant tumors, very different from 
true cancer. A scirrhus tumor, therefore, is not per se the proof of 
an approaching cancer. Indeed, some authors have grouped together 
scirrhus, medullary sarcoma, fungus hrematodes, and carcinoma, as 
constituting species of the generic family of cancer. But it is enough 
for practical purposes, to know that a scirrhus tumor may become a 
caucer or some other malignant ulcer ; and when the surface of the 
acirrhus is uneven to the touch, the skin leaden and wrinkled, with ir- 



rUMORS 347 



regularly dilated veins, and twinging, gnawing, or lancinating pains, the 
cancerous character is clear. 

Diagnosis. — Non-canceroid scirrhus, and all hardened but non-malig- 
nant tumors, are never preceded by nor attended with pain of the 
gnawing or lancinating kind. They present, also, a smooth and more 
rounded surface, with a manifest swelling in instead of out of the part 
in which they are found; whereas, in canceroid scirrhus, the part 
affected is condensed and really diminished in bulk. 

Treatment. — Scirrhus or hardened tumors resulting from inflamma- 
tion may be dispersed by the plan of treatment recommended for 
bronchocele. But the canceroid tumor, in its early stage, may, per- 
haps, be treated with equal success by the knife or caustic; and in 
either case care must be taken to remove or destroy every vestige of 
discolored skin or affected flesh. 

Open cancers can be and frequently are cured by a free application 
of caustic potash, although the operation is a painful one. Dr. Hill 
advises, in the scirrhus stage, the application of a pencil of potassa, so 
as to surround completely as well as to open the cancerous mass, letting 
it penetrate into the very center from several different points; and if 
the patient cannot, bear so extensive an application at once, the caustic 
may be applied to different parts from day to day. Between the cau- 
terizations the sore is to be covered with a poultice of slippery elm 
flour. In the open cancer the caustic potash is to be applied freely to 
I he whole of the ulcerated surface; burning to the bottom of the tu- 
mor by striking the pencil in from different directions. When the 
eschar sloughs oft", any remaining portion of the morbid growth should 
be touched with the caustic; and these applications are to be continued 
and repeated until all of the morbid structure is destroyed. During 
the healing process the sore is to be washed daily with the mild caus- 
tic— sesqui-carbonate of potash^-to destroy the vitality of any rem- 
nant of cancerous virus that may exist, and prevent the development of 
new. The constant application also of flour, starch, or slippery elm, 
absorbs the pus, and thus prevents its corrosive effect. When this or 
any. other operation is resolved upon, the body must be prepared by a 
thorough course of hydropathic bathing and dieting. 

Fungus Hjematodes.— This term means bloody fungus ; the dis- 
ease is sometimes called medullary sarcoma, spongoid inflammation, 
encephaloid tumor, and soft cancer. It commences with a small, elas- 
tic, movable, and nearly insensible tumor, under the skin, the integu- 
ment itself being unaffected. Sooner or later it becomes inflammatory, 
swells rapidly, the skin becomes discolored with purpl'sh or red spots 



SURGERY. 



and adheres firmly to the distended and tabulated mass. Ulceration 
soon comes on; dark-coloreJ fungous growths sprout out irregularly 
and at several points beyond the surface ; the whole mass becomes 
exceedingly vascular, the top being much larger than the base ; event- 
ually the idjacent glands are affected, when the patient's general 
health rapidly declines. 

Treatment. — When the lymphatic glands have become affected, the 
disease may be pronounced incurable. In its early stage, while the 
tumor is loose underneath the skin, and nearly free from active inflam- 
mation and te._ ciii'^j 01 pressure, it may bo destroyed by caustic or 
removed with the knife. The knife is preferable when the diseased 
mass is so situate! chat the whole can be removed at once. The ex- 
cision should include every particle of morbid structure; and to make 
sure of this the dissection should extend some distance beyond all ap- 
pearance of disease. When cauterization is resorted to it must be 
managed, as in the case of common cancer, except that it is more im- 
portant to destroy, if possible, every vestige of the diseased mass by 
the first application. 

Bone Cancer — Osteo-Sarcoma. — This disease, called spina 
ventosa by some authors, consists in the deposition of a flesh-like mat- 
ter in the structure of the bone, producing a morbid enlargement. 
As the disease progresses, the i-ateynal structure is changed to a 
brownish, fleshy mass. When the swelling opens on the surface, 
large quantities of pus, of a more or less ichorous or sanious character, 
are discharged. The affection is most frequently seen in tho lower 
jaw bone. The early symptoms are, acute pain, followed by a hard 
elastic swelling, after which the pain becomes more dull, and eventu- 
tually lancinating. 

Treatment*— The first thing to do— except when a part or limb is so 
far destroyed as to require amputation or forbid any attempt to cure- 
is to cauterize an opening into the center of the diseased mass, so as 
to allow the free escape of purulent matter and loose pieces of bone; 
the limb or part is then to be kept well covered with wet compresses, 
and, when practicable, the cold stream or pouring-bath should be fre- 
quently applied ; the eavily should be washed out once or twice a day 
with tepid water; and, if there are fungous growths appearing, a solu- 
tion of the mild caustic should bo applied daily, filling the cavity, after 
each application, with pledgets of lint. 

Carbuncle— Anthrax.— This affection is sometimes called a ma- 
lignant boil. It commences wifh a livid, red swelling, attended with a 



TUMORS. 349 

burning, smarting pain, followed by vesication ; the ulceration appears 
in the form of several fistulous openings, from which a thin, acrid fluid 
exudes, excoriating the adjacent surface. The disease always indicates 
a very depraved or debilitated state of constitution, and rarely occurs 
in any but aged persons. It is generally located in some part of the 
back or on some portion of the head. 

Treatment. — The best management, in the most malignant forms is, 
without doubt, the cauterization plan recommended for the preceding 
disease. There is much less pain attending the application of caustic 
in carbuncular than in cancerous or malignant fungous tumors. But 
the less virulent cases, wherein the fetor is moderate and the gan- 
grenous tendency slight, may be cured by thorough packing, a rigid 
diet, and wet compresses. 

Lupus — Noli-me-Tajygere. — Lupus literally means "the wolf;" 
and noli-me-tangere, "don't touch me" — terms expressive of the ra- 
pacity and abhorrent nature of this excrescence. It is a malignant 
disease, usually about the nose and mouth, commencing as a small tu- 
mor, and progressing to a foul ulcer. Its first appearances are various, 
as a small dark sore, tubercle or vesicle, or a large, prominent wart. 
The lupus ulcer is known by a purple margin and depressed center, 
which exudes a tenacious pus, or an ichorous matter ; the exposed 
surface has a fiery red appearance, and the pain is of a pricking or 
smarting kind. When occurring near the eye, it will, if not arrested, 
destroy that organ, and may extend to the brain. The general health 
is not usually much affected. 

Treatment. — In the early stage, when the disease appears in the 
shape of warty excrescences or tubercles, the knife or caustic may be 
employed indiscriminately. When it commences as a superficial, red, 
angry sore, the mild caustic will be sufficient. When it has extended 
over a large surface, or penetrated deeply, the strong caustic must be 
freely applied. 

Aneurism. — An aneurismal tumor, in its strictest sense, is a preter- 
natural dilatation of the coats of an artery, forming a pulsating swelling, 
which eventually ruptures and destroys the patient .by hemorrhage. 
The term is also applied to enlargements of the cavities of the heart 
In the true aneurism the coats of the artery form the pouch or sac of 
the tumor; when the sac or covering is formed of effused lymph, into 
which the blood has escaped from the artery, it "is called false aneu- 
rism ; sometimes the blood is poured into the cellular membrane, con- 
stituting the diffused aneurism ; and when the effused blood, in conse- 
30 



350 SURCJEIIY. 

q7ence of a rapture of the internal and middle coats of an artery 
makes itself a channel bttween these and the oute- .oat, it is called 
dissecting aneurism. Aneurismal varix-varkose aneurism* o Na- 
tation of a vein in consequence of a gush of blood from a neighboring 
artery, and is generally produced by " venesection." Neevus is a dila- 
tation of the small arteries, producing a red, shining spot on the skin ; 
when these vessels are larger, the affection is called aneurism by anas- 
'omosis. 

Diagnosis.— Aneurism, when external, is known by a pulsating tu- 
l-;, or, which beats synchronous with the artery where it occurs ; it may 
be diminished or emptied of its contents by pressing on the affected 
artery above the tumor. Internal aneurisms, which occur in the heart 
or large vessels of the chest and abdomen, are extremely difficult to 
distinguish. Aneurisms of the heart are divided into active and pas- 
sive ; the former is really a hypertrophy or thickening of the parietes 
of the organ, by which its cavities are diminished; the latter is the true 
cardiac aneurism, attended with an enlargement of its cavities. The 
symptoms in all these cases are exceedingly obscure and variable, and 
are common to nervous and dyspeptic invalids, as well as the result of 
various tumors and visceral enlargements not connected with any struc- 
tural lesions of the circulating system. The most prominent, however, 
are, a strong and constant beating or pulsatory motion above or below 
the sternum, when, the bowels are not constipated; a dull, heaving, beat- 
ing, or boring sensation about the spine ; and a double beating, or some 
other uniformly irregular character of the pulse at the wrist. 

Special Causes.— Injuries, blows, falls, violent exertions, mental excite- 
ment, and above all, obstructing, concentrated, and greasy food, which 
thickens the blood and increases the labor of the heart and arteries in 
propelling it. 

Treatment. — In the early stage of aneurismal tumors, compression, 
when it can be managed by an experienced operator, is the best reme- 
dial resource. In other states and circumstances, the ligature is neces- 
sary. The most approved operation is that of tying the artery with a 
single ligaturo above the tumor. After dissecting down to the vessel 
affected, the blunt end of an aneurism needle, fig. 199, should be work- 
Fig. 199. 




T "J M R S. 351 

ed around the vessel to separate it from its accompanying vein or nerve; 
this may be done by pushing rather than cutting, to avoid wounding the 
the nerve or vein. The ligature is improper in false aneurisms of large 
extent, after the pulsation has ceased in the tumor, and when caries or 
gangrene exists in the vicinity of the disease. After the obliteration of 
the cavity of the diseased vessel, the anastomosing vessels in its vicinity 
will enlarge to maintain the necessary circulation. 

In varicose aneurism the vessel must be tied both above and below 
the injury ; this double ligation is necessary also in localities where 
there are numerous anastomosing branches, as on the dorsal surface 
of the hand and foot. 

The constitutional treatment is of first importance in all cases of or- 
ganic diseases of the blood-vessels. 

The diet must be simple, bland, and opening; all violent exercises of 
body or mind strictly avoided, and all bathing appliances must be mild 
and gentle, so as to prevent any shock to the circulation. 

Varix.— Varices or varicose veins are tortuous, knotty, elongated 
thickenings and dilatations of the coats of these vessels. Varicose en- 
largements are most frequently found in the lower extremities, the 
great saphenal vein and its branches being the affected vessels; the 
spermatic and hemorrhoidal veins are also very liable to become vari- 
cose. In many cases the valves of the veins are destroyed ; the af- 
fected vessels are liable to inflammation ; and the lower limb is partic- 
ularly disposed to ulceration, which bleeds easily and heals with great. 
difficulty. Varicose ulcers have existed twenty and thirty years, ren- 
dering the limb almost useless. 

Treatment. — Compression with the common bandage or roller, when 
skillfully managed, will often cure varices of the lower extremities. 
Surgeons have experimented largely in several processes — cirsotomy 
or incision, extirpation, ligation, and % cauterization — but with very poor 
success in all. A plan for obliterating the vessels by the combined ac- 
tion of caustic and compression has been successful in many cases. It 
consists in the application of caustic to one or two very small portions 
of the distended veins at a time, so as to produce ulceration and ulti- 
mate adhesion, the part being, meanwhile, dressed with adhesive plas- 
ter or the wet roller. As soon as one dilatation or knob is obliterated, 
the caustic may be applied to another, and so on. I regard this prac- 
tice as perfectly safe provided due attention is paid to bathing and 
dieting. 

Whitk Swelling — Hydrarthrus. — This formidable disease com 



862 SURGERY. 



monly affects the knee-joint. Authors make two varieties, scrofulous 
and rheumatic, as it appears in persons predisposed to, or afflicted with, 
either of those complaints. 

Symptoms. — The swelling comes on very slowly, and is attended 
with little pain at first. Gradually the pain increases till it becomes 
intense, especially at night. The skin appears whiter than natural, 
becomes tense, shining, and marked with varicose veins, and there is a 
constant sensation of heat in the part. In this condition it may remain 
for years, but usually the swelling continues to increase until the soft 
parts become so hard as to appear like enlarged bone. As it progress- 
es the tibia is thrown backward, the condyles of the femur project for- 
ward, the whole limb emaciates,, anchylosis takes place while the joint 
is flexed, and matter collects, and is discharged at various sinuous open- 
ings. Extensive caries of the bone often ensues, with hectic fever, 
soon terminating in death. 

Special Causes. — Repelled eruptions, local injury, mercurial and 
antiinonial medicines, syphilitic taint. 

Treatment. — This is one of the maladies which the popular "heal- 
ing art" does not pretend to heal. When the joint is very painful, it 
should be bathed in warm water or fomented until this is relieved, and 
then dressed with several folds of wet cloth, except when the inflam- 
mation is acute, in which event cold applications are most appropri- 
ate, the rule being, as in all similar cases, to regard the sensation of 
the affected part. The cold pouring-bath, douche, or leg-bath, or even 
moderate congelation, may be employed with advantage when the 
sensibility of the part is such that they can be administered without 
pain. Indeed, in most cases they will each and all have a soothing and 
sedative influence. Callous edges of the ulcerated surfaces, sinuses, and 
fungous growths, will require the application of the mild or strong caus- 
tic. The limb should be kept as extended as possible, and as much 
compression employed during the suppurative stage as can be borne 
without pain. To these local measures must be added thorough con- 
stitutional treatment, in which the packing-sheet should be the leading 
process. The regimen must be such as has been heretofore recom- 
mended for scrofula. 

Hydrops Articuu. — This is usually regarded as a result of rheu- 
matic disease, and hence called rheumatic white swelling. It consists 
in a distention of the synovial membrane and capsular ligament by 
serous effusion, which renders the limb lame and stiff, though not very 
painful except from exercise. Sometimes the effusion extends nlonj,' 
the tendons of the muscles. The warm or cold douche, wet bandages, 



UMORS 353 

the pack-sheet, copious water-drinking, and frequent injections to keep 
the bowels entirely free, are the remedial measures. 

Varicocele — Circocele — Spermatocele. — A varicose dilata- 
tion of the veins of the scrotum and spermatic cord, is called indiscrim- 
inately by these terms. When the spermatic veins are affected, the 
tumor is soft, knotty, doughy, unequal, and compressible, increasing 
from below upward. The disease requires no special attention, save a 
careful regard to hygienic habits ; occasional sitz-baths, or the ascend- 
ing douche, with the use of a suspensory bandage. 

Hematocele. — This is an extravasation of blood in the tunica vag- 
inalis, or an effusion into the cellular membrane of the scrotum. The 
external parts are often thick and dark, somewhat resembling gan- 
gi'ene. The treatment is the same as for the preceding affection. 
Sometimes the disease is produced by the wounding of some large 
vessel, in which case the scrotum may be laid open and the vessel tied. 

Sarcocele. — This term is variously applied to a scirrhus or can- 
cerous, encysted, or fibrous tumor of the testis, and to a simple enlarge- 
ment as a consequence of maltreated chronic inflammation. When 
the tumor is malignant, castration is the only sure remedy ; other- 
wise it may be reduced by the remedies recommended for the prece- 
ding maladies. 

Hernia Humoralis. — This technic is applied to a swelled testicle 
from common inflammation, or to a hardened tumor which is at first 
confined to the epididymis, the pain extending along the cord to the 
loins. The lntter variety is frequently the result of a suddenly-sup- 
pressed gonorrheal discharge. The former variety requires cold, and 
the latter ivarm water-treatment at first, to be followed by cool, and 
finally cold applications. 

Cystic Sarcoma. — This is a hydatid disease of the testis. It oc- 
curs chiefly in middle life, and is sometimes mistaken for hydrocele ; 
but the oval shape of the tumor will readily distinguish it from that af- 
fection which is pyriform. The morbid mass consists in part of a solid 
structure, and partly of cysts of various sizes, containing a thin, trans- 
parent, yellow serum, or a turbid fluid. The complaint had belter be 
managed on the " let alone" system, unless its bulk or malignancy cre- 
ates great inconvenience or suffering, in which case extirpation is the 
only remedy. 



364 SURGERY. 



Polypi. — The most common situations for polypus tumors are the 
nose and vagina, although they may grow from any introverted rau- 
cous surface. For ali practical purposes, it is sufficient to distinguish 
them into soft and hard, although surgical writers have made several 
subdivisions of each, as mucous, vesicular, fibrous, fleshy, scirrhus, or 
cancerous, etc. The latter variety is probably a true cancer, instead of 
a cancerous polypus. 

Treatment. — In addition to what has been heretofore said in relation 
to the treatment of these morbid growths, it may be remarked, that the 
application of powdered caustic — either mild or strong, according to the 
firmness of the tumor — will frequently be sufficient to destroy them. 
In many cases the caustic may be advantageously combined with me- 
chanical force, as squeezing, twisting, crushing, etc., tearing away 
such parts as may be conveniently detached. The powder should be 
applied with a camel's-hair pencil. This plan is particularly adapted 
to nasal polypi. The practitioner should also bear in mind that nasal 
polypi are very liable to grow again, after having been removed by me- 
chanical means, unless the surface from which they are detached is 
thoroughly cauterized. 

Polypi in the vagina, whether originating from its sides or from the 
mucous surface of the uterus, usually present a pedunculated shape, 
which is favorable to the operation of removal by ligature. I have 
known cases connected with such a degree of prolapsus as to allow the 
application of a ligature without any instrumental assistance ; but gen- 
erally the ligature will have to be introduced by. means of the polypus 
forceps, or the double canula, fig. 200, after which it is to be drawn 



Fig. 200. 




DOUBLE CANULA, WITH LIGATURE. 

tight enough to cut off the circulation and strangulate the tumor; the 
canula is to remain, and the ligature tightened from time to time, until 
the tumor comes away, which will usually be in five or six days. 
When the neck of the polypus cannot be reached by ligature, the tu- 
mor may be destroyed by a solution of the caustic potash, introduced 
through a silver catheter; or the powdered caustic may be applied by 
means of pieces of fine sponge, with threads attached to withdraw 
them. 



TUMO R S. 355 

Nodes. — A majority of bone tumors are included under the term 
exostosis, and the term node is usually restricted to hard concretions or 
incrustations which form around rheumatic and gouty joints. It is em- 
ployed, however, by several writers, synonymously with exostosis ; and 
many authors apply it to tumors of the cylindrical bones resulting from 
the venereal taint. It is the opinion of some surgical authors that 
syphilitic nodes only occur in persons who have taken mercury, which, 
by the way, has inflicted vastly more mischief on the human constitu- 
tion than has the disease it is intended to cure. 

Samuel Cooper says (Coojyer's Surgery), '• I believe that true nodea 
are rarely produced in syphilis, unless the patient has been using mer- 
cury." Dr. Hennen, who had an extensive experience in the treat- 
ment of syphilitic diseases, affirmed that he had never seen but two cases 
of nodes in patients who had not taken mercury ; and in relation to those 
two cases the question may be fairly raised, Whether the patients had 
not taken mercury on some previous occasion. 

Treatment. — This is mainly constitutional. Thorough general bath- 
ing, an abstemious diet, and local compresses, are the leading meas- 
ures. When the tumor becomes projecting and pointed, the soft parts 
may be laid open, and the tumor removed with a saw, chisel, or tre- 
phine; when ulceration occurs, attended with callous edges or fungous 
excrescences, these require cauterization. 

Enlargement of the Prostate Gland. — In this affection the 
gland often attains many times its ordinary size, and is much harder 
than natural. It produces but slight difficulty in urination, yet it pre- 
vents the bladder from being completely evacuated, and the urine is, 
in consequence, rendered constantly turbid. Total retention of urine, 
however, is liable to occur if the swelling is aggravated by any ex- 
cesses to which the patient is addicted. There is a sense of weight in 
the perineum, and the middle lobe of the gland usually projects into 
the bladder, altering the shape and direction of the urethra, and ren- 
dering the passage of a catheter or sound more or less difficult. The 
disease is usually caused by calculous concretions or venereal affec- 
tions. 

Treatment. — Frequent hip-baths, and a thorough employment of 
the ascending douche are the ordinary local appliances ; to which must 
be added some general daily bath, as the dripping-sheet, or pack and 
half-bath. When it is produced by repelling or suddenly drying up a 
gonorrheal discharge, warm hip and foot-baths must be assiduously 
employed until the discharge reappears or the irritation subsides; after 
which the cold treatment may be employed as above. 



866 SURGERY. 



CHAPTER A 



Ulcers are purulent solutions of the continuity of the animal tex- 
ture. In a general sense, they are distinguished into the benign, or 
healthy,'&nd the malignant, the indolent, and the irritable, etc. They 
are also subdivided into many varieties, according to their causes, na- 
ture, tendencies, consequences, etc., as simple, sinuous, fistulous, fun- 
gous, gangrenous, cancerous, scorbutic, syphilitic, scrfulous, inveterate, 
phagedenic, virulent, sordid, cacoethic, carious, varicose, etc. Many 
tumors, if not arrested in their early stage, become ulcers, as cancer, 
carbuncle, etc. 

An ulcer is called healthy when its purulent matter is a normal se- 
cretion, unattended with the destruction of the surrounding parts. Its 
surface is florid ; its granulations are small and of uniform size ; it is 
without offensive smell ; and it heals regularly, leaving little or no scar. 
A common boil is an example. 

An irritable ulcer is very tender to the touch ; extremely liable to 
bleed ; its discharge is slight, and of a thin, ichorous, or sanious ap- 
pearance ; its color is dark or purplish ; its granulations are imperfect 
and spongy ; its edges are ragged and everted ; the parts around are red, 
swollen, and often cedematous. 

The indolent ulcer is the more frequent form of "running sore" we 
meet with ; its edges are inverted, rounded, thick, glossy, and regu- 
lar ; the granulations are of a dull pale aspect, and insensible ; the pus 
is thick, of a dark yellow color, and adheres to the bottom of the ulcer. 
It is most frequently located on the lower extremities. 

Varicose ulcers may be either irritable or indolent ; they are con- 
nected with enlargements or varices of the adjacent veins. They are 
generally situate below the knee. 

Fistulous ulcers are sinuous cavities, having a narrow outlet, the dis- 
ease being kept up by an altered texture of the part. 

Specific ulcers result from the inflammation of specific diseases, as 
scrofula, salivation, syphilis, etc. Other distinctions, depending on mere 
varying appearances, or on common causes and terminations, are of 
no practical importance. 

General Treatment of Uljers. — The constitutional treatment 



ULCERS. 357 

is always of primary importance in chronic ulcerations of every kind. 
In all matters of regimen the patient must be held to a strict accounta- 
bility to physiological law. The whole skin must have, at least, one 
thorough daily ablution or packing. The local medication will vary ac- 
cording to the character of the ulcer. The healthy ulcer needs nothing 
more than a cool wet cloth. When the irritable ulcer is very painful, the 
limb or surrounding part may be fomented with warm cloths until it 
becomes easy, and then "done up" with the ordinary "water-dress- 
ing." When exposure to the air aggravates the pain, the surface may 
be covered with flour. The indolent ulcer often requires the applica- 
tion of the mild caustic to remove fungous growths or callous edges. 
When the surrounding parts are hard, they should be occasionally fo- 
mented ; and if the sore is on the lower extremity, compression with 
the roller or by adhesive straps is useful. Varicose ulcers require 
still stronger compression ; the roller bandage should be applied to the 
whole limb, and the sore treated in other respects according to its 
character. When the veins are extremely distended and knotty, ad- 
hesive straps may be advantageously applied over and adjacent to the 
ulcer ; and these may be covered by the roller. Cauterization of each 
distended vein with potassa fusa, one or two inches distant from the 
ulcer, so as to obliterate their cavities by adhesive inflammation, may 
bo resorted to in bad cases with safety, and usually with success. Fis- 
tulous ulcers generally require to be opened with the ligature, or ob- 
literated by caustic. 

Furunculus. — A boil, or bile, as some authorities have it, is a small 
phlegmon, seated in the dermoid texture, and tending to a pointed tumor 
which sooner or later breaks and discharges a white or yellowish pus, 
mixed with blood. Sometimes a small fibrous mass of dead but undis- 
solved areolar tissue appears, after it suppurates, called the core. The 
only medication demanded is the wet dressing; and, should the tumor 
not open spontaneously when matter has evidently formed, it should 
be punctured with a lancet and the matter pressed out. 

Parulis. — The common gum-boil is a small abscess which frequently 
forms in the gums. It is sometimes owing to carious teeth, but is gen- 
erally produced by bad dietetic habits. Those who eat coarse vegetable 
food, and use the tooth-brusb daily, are seldom troubled with such 
affections. 

Fever Sores. — The most common form of chronic ulcers are 
Known as "fever sores," " brandy sores," " whisky sores," etc., and some- 



358 SURGERY 



times, in view of their usual lucidity, "old sore legs." They are gen- 
erally connected with and the penalty of intemperate habits. I have 
known several bad cases among the children of liquor-drinking parents. 
The ulcers are deep, the limb is swollen, in some cases nearly as hard 
as bone, and frequently purple or dark. The character of the sore 
may be irritable, or indolent, or of a mixed character, some portions 
being irritable and others indolent. 

Treatment. — These cases require a long course of treatment, but 
can generally be cured, provided the patient will sign and then keep 
the temperance pledge. When painful, they are to be soothed with 
warm water or the warm fomentation ; when hot and inflammatory, 
the cold douche should be applied to the whole limb daily. Callous or 
fungous excrescences are to be destroyed by caustic. The roller ban- 
dage is also an indispensable part ef the treatment. It must be ap- 
plied twice a day — every morning and evening is a good rule — and 
thoroughly wetted with cold water after it i3 applied; wet cloths 
should always be placed over the bandage when there is the least pre- 
ternatural heat or active inflammatory excitement. All these meas- 
ures, however, will fail, unless the whole surface is thoroughly attended 
to in the way of bathing ; and the stomach and bowels are kept unbur- 
dened and well cleansed by the appropriate quantity and quality of 
food. 

It is a prevailing opinion among drug-physicians, and a popular pre- 
judice with the people, that it is dangerous to cure old sores. Truth, 
"they say," lies between two extremes. The truth in this case, as in 
all others, is at one extremity. It is always dangerous to heal them 
drug-opathically, but never dangerous to cure hydropathically. 

Caries and Necrosis. — These terms are often employed synony- 
mously ; but in strict surgical parlance, caries is an ulceration of the 
bony structure, analogous to gangrene of the soft parts ; while necrosis 
is the death of the bone, analogous to nortification. Caries usually 
attacks the spongy bones, as the vertebrae ; and necrosis as generally 
affects the long or flat bones, as the tibia, humerus, and bones of the 
cranium. Necrosis in the leg or arm is generally called " fever sore." 
The process by which dead portions of bone separate from the living — 
analogous to sloughing of the soft parts — is called exfoliation. 

Sym-ptoms. — The bones, though insensible in their healthy state, be- 
come exceedingly painful when diseased. The swelling has no regular 
apex or point, but is more distressing than ordinary inflammatory 
swellings, especially at night. The part is hot, somewhat livid, and 
sometimes come? on suddenly and progresses rapidly to suppuration. 



ULCERS. 359 

The pus is dark, sanious, and foetid, and generally discharged through 
several fistulous openings or pipes ; and through these the rough, un- 
even surface of the bone can be felt by means of the linger or common 
probe. Sometimes the bones of the cranium are perforated at numer- 
ous points, constituting the worm-eaten caries of authors. There is 
more or less fever, which is of the hectic character. When necrosis 
occurs in the center or shaft, of the long bones, it seldom or riever ex- 
tends to their articular extremities ; but the exterior layers form a 
canal around the dead portion, which is called sequestrum ; and between 
these swollen layers and the sequestrum suppuration takes place. 

Special Causes. — Professor Parker disposes of the causes of necro- 
sis in the following summary manner : "So far as any thing can be 
known, it seems to be the result of sudden changes of temperature." 
But the fact that both caries and necrosis frequently follow local inju- 
ries, as blows and falls, and are also frequently connected with consti- 
tutional taints, as scrofula, scurvy, syphilis, mereurialization, etc., seems 
to indicate that something should be known beyond mere temperature. 
The greatest number, as well as the most malignant kinds of caries 
and necrosis owe their existence to the combined action of mercury 
and syphilis, or mercury and scrofula; or, in the language of Samuel 
Cooper, "to the prejudicial influence of a badly conducted course of 
mercury." 

Treatment. — In its forming stage the disease can generally be "dis- 
cussed" by douching the part frequently with cold water, the constant 
application of wet cloths, and one or two packs daily. The late Pro- 
fessor Nathan Smith recommended making a free incision down upon 
the bone, and even into its substance, if relief from pain did not follow 
the first incision, on the plan of treating a felon or whitlow ; and no 
doubt such a practice in a very early stage, would lessen the extent of 
the inflammation : still if the cold-water measures are vigorously em- 
ployed it will be unnecessary. After ulceration has taken place, " the 
books" furnish us with any number of vinegar-and-meal, carrot-and- 
onion, bread-and-milk, soap-and-molasses, rum-and-sugar, scraped-po- 
tato, tobacco, strammonium, etc., poultices, to help " digest" the affair; 
but 1 know of nothing in theory or in experience which gives them any 
advantage over a few folds of old linen rags well wetted in pure soft 
water, provided the temperature is duly regulated. 

But when the disease proceeds to suppuration and exfoliation, it is 
important to get rid of the purulent matter and dead bone as fast as 
possible, yet all rough handling of the diseased part must be avoided. 
If any portion of bone becomes loose or projecting, or can be ascer- 
tained to be dead — in which case its color will be whiter or darker than 



StiO SURGERY. 



natural — the caustic should be applied to it. " The mild caustic," says 
Dr. Hill, " has a peculiar effect on diseased boue, and seems to exert 
a stronger influence than the bi-carbonate, or even the pure alkali — 
caustic potash — without any injury to healthy parts." When there 
are several openings they should be converted into a single ulcer if 
possible ; for which purpose the caustic, knife, or ligature may be em- 
ployed according to circumstances. Dead bone and fungous growths 
may be dissolved by passing tents, charged with the sesqui-carbonate 
of potash, into the sinuses, and pushing them against the morbid struc- 
ture. Sometimes new bone is formed around the dead part, inclosing 
it in a shell, and producing a preternatural enlargement of the part ; 
au opening, kowever, is usually left in the new formation, through 
which purulent matter issues. This opening must be enlarged by 
caustic sufficiently to allow of armed tents or caustic solutions to be 
passed through a tube or syringe to the dead bone, to effect its disso- 
lution. After every vestige of disorganized matter has been removed 
from the ulcerated cavity the ulcer will heal kindly ; yet the bone will 
generally remain preternaturally enlarged. 

Fistula in Ano. — Any abscess about the rectum, opening either 
within or without the anus, or both, is known by the term, fistula in 
ano. Fistulas are so common in this situation, that some physicians, 
whose practice, "from being general is confined to a particular branch 
of their profession," have selected "diseases about tho anus" as the 
particular field which is to engage their "profound attention." Fistula? 
in ano are usually connected with piles, and both have habitual costive- 
ness as their common cause, although the former is sometimes occa- 
sioned by wounds and injuries. 

When there is an open communication between the rectum and the 
cutaneous surface, the fistula is called complete ; and incomplete or blind 
when it communicates with but one ; the latter is called blind internal 
or blind external fistula, as it opens into the bowel, or upon the exter- 
nal skin. In a majority of cases the fistulous pipe, or sinus, is tortu- 
ous and branching, several distinct openings being internally connected. 
Tbo sinus is lined with a semi-cartilnginous, or callous growth, having 
the secreting property of mucous membrane, from which exudes a 
thin, yellowish pus; this indurated surface is generally extremely ten- 
der to the touch. 

Treatment. — The "standard authors" on surgery are surely not 
well pasted in the matter of curing the disease under consideration. 
Their plan of laying the ulcer open with the knife is always barbarous, 
generally unsuccessful, and sometime* fatal. More than twenty years 



ULCERS. 361 

ago a self-constituted reform school of medicine in the city of New 
York, published to the world (Dr. Bedell's American Practice of Med- 
icine) a successful method of treatment ; vet we do not find the regular 
professors adopting or commending it, perchance on account of its ir- 
regular origin. The main features of this method consisted in substi- 
tuting the ligature and the caustic for the knife and the scarificator. 

The first process is to subdue the inflammation and overcome the 
irritable condition of the ulcer, for which purpose frequent warm hip- 
baths, with the wet compresses, must be employed ; after which the 
exact state of the cavity may be ascertained by the probe. The com- 
plete fistula may be ligated by passing the threaded probe from the ex- 
ternal to the internal orifice, the string being brought down by the fin- 
ger introduced into the rectum. The ligature is to be tied as firmly as 
the patient can well bear, and tightened a little daily. Dr. Hill's meth- 
od — the best extant — of tightening the ligature is, before tying, to let 
the ends of the string pass trough a large vial cork, separating three 
fourths of an inch where they emerge, and passing over a little wooden 
roller, fitted to radial grooves cut on the end of Fig 201 

the cork, fig. 201. These notches will hold the stick, 
after turning or twisting to tighten the string. 

While the process of ligation is going on, the 
caustic powder must be inserted by means of 
pledgets of lint to act upon and dissolve the cal- 
lous or cartilaginous growths. If several sinuses 
exist they must all be managed in the same way, 
and every callous fissure must be thoroughly 
cauterized. The part should be frequently bathed 
or fomented with warm water when painful, and 
several folds of wet cloths, covered with dry, 
kept constantly applied, being retained in place 

, _. , , FISTULA LIGATURE. 

by a T bandage. 

When branching sinuses lead into or from the main one, they should 
be enlarged, and all the callosity along their course destroyed by the 
armed tent. A blind internal fistula should be opened with a pointed 
probe or the caustic, at the point nearest to the external surface, thus 
converting it into a complete fistula to be treated as above. The blind 
external fistula can often be cured by the armed tent alone ; but if this 
fail, the threaded probe can be passed through the bottom of the sinus 
into the rectum, and the ligature applied. 

It will usually take several months' time to cure bad cases of this af- 
fection ; and during the whole course of treatment the patient's diet 
should.be extremely simple, the bowels kept entirely free by injections, 
11—31 




SURGERY. 



and he should keep very quiet, resting much of the time in the hori- 
zontal position. 

Fistula in Perineo. — A sinuous ulceration in the perineum is 
generally the result of a stricture in the uiethra; the urine, thus ob- 
structed, acting upon the lax structures of the part, often occasions ex- 
tensive ulcerations, attended witn very offensive discharges of purulent 
or sanious matter. 

Treatment. — After the stricture has been removed, or the urethra 
dilated, as the case may be, a gutta percha catheter should be intro- 
duced into the bladder, and worn constantly ; the hard, callous edges 
of the ulcer are then to be disorganized by the repeated application of 
the mild caustic, or the pure potash, if necessary. Before applying the 
caustic, the parts should be soothed with warm fomentations ; and if 
the urethra is too irritable for the constant employment of the cathe- 
ter, the patient should keep on his back while it is withdrawn, taking 
care to have the instrument introduced before he rises, so that the 
bladder may be emptied without allowing any urine to come in contact 
with the ulcerated parts. 

Strictures and Fissures. — Strictures and fissures of the urethra 
and rectum, though not in any sense ulcers, are so intimately con- 
nected with fistula; that they may as well be considered in this place. 
The membranous portion of the urethra, between the bulb and the 
prostate gland, is most frequently strictured, although a stricture may 
occur at any part of its channel. The disease may be spasmodic or 
organic. In the former case obstruction is temporary, and is produced 
by a partial or total obliteration of the canal in consequence of its sides 
being pressed together by the contraction of the surrounding muscular 
fibres. In the latter form the obstruction is permanent, and results 
from a morbid thickening of the mucous membrane. A partial organ- 
ic stricture may become total by spasmodic action, superadded to the 
structural difficulty. The most frequent cause of stricture is gonor- 
rhea, or rather, the irritating drugs which are employed to cure it. In- 
juries from the passage of stone or gravel, and by surgical instruments, 
sometimes produce it. 

Symptoms.— The spasmodic stricture is known by the sudden stop- 
page of the stream after it has reached the irritable spot ; there is also 
a desire to urinate frequently and hurriedly. In the organic stricture 
the stream becomes crooked, gradually diminishes, and at length di- 
vides, and finally passes only in drops. The excretion eventually be- 
comes yellow and purulent, evincing ulceration in the urethra or blad- 



ULCERS. 363 

der. The constant habit of straining often induces hernia or piles ; 
and when extensive ulceration has taken place, rigors and hectic fever 
are the precursors of a fatal termination. 

Treatment. — The first measure is to relieve the bladder. "When 
the stoppage occasions a tense, round, painful distention above the 
pubes, the catheter must be employed ; the gonorrheal inflammation or 
irritation, when it exists may be subdued by frequent warm hip-baths, 
followed by tepid, then cool, and finally cold ; the bowels must be kept 
free by a simple opening diet, with tepid injections when necessary; 
and cold water should be drank as copiously as the stomach can com- 
fortably bear. With the subsidence of the morbid irritation, the spas- 
modic stricture will usually disappear ; but if not, the additional meas- 
ures are necessary, which pertain particularly to the treatment of per- 
manent stricture. These consist in dilating the urethra by means of 
gum elastic or gutta percha bougies, or destroying the stricture, which 
is usually confined to a very small space, by the application of caustic, 
or both. The dilating process is managed by introducing a very small 
bougie at first, and after it has been worn as much of the time as pos- 
sible for a day or two, a larger one, and so on, until the constricted 
calibre is enlarged as much as possible. If sufficient relief is not ob- 
tained by dilatation, the caustic is the dernier resort. This is applied 
by means of a bougie armed with caustic potash, or nitrate of silver, 
and passed to the strictured point, against which the caustic is pressed 
for about one minute at a time. If there are several strictures, each 
must be cauterized successively. Another method, called malaxation. 
which consists in introducing a bougie through the strictured portion, 
and retaining it as long as possible, during which time pressure is made 
against the stricture by an external compress and bandage, to excite 
absorption, has been frequently successful. During all or any of these 
operations, the irritation must be kept down and constant relaxation of 
the parts maintained by very frequent warm hip-baths or fomentations. 
Indeed, a majority of cases will yield to the medical part of the hy- 
drotherapeutic treatment, without any resort to mechanical surgery 
whatever ; and the cases are extremely rare which will require any 
mechanical operation except the dilating process, provided all the pa- 
tient's habits and management are thoroughly hydropathic. It should 
be generally known that, as a majority of stricture-', of both the spas- 
modic and permanent kind, are produced by astringent and irritating 
applications employed to check gonorrheal or gleety discharges, so a 
majority will get well by reproducing the discharge ; and this may gen- 
erally be done by the persevsring employment of warm local baths and 
fomentations. 



864 SURGERY. 



Stricture of the rectum is a thickening and hardening of the intes- 
tine, resulting from constipation ; it produces a serious difficulty in 
passing the faeces, which are evacuated in small, contracted, elongated, 
or flattened lumps, or in a fine stream. As in the case of fistulae, all 
callous formations must be removed by caustic ; and the constricted 
intestine must be mechanically dilated. Apiece of ordinary wood, cov- 
ered with oiled silk, of a conical shape, about three inches in length, 
the smaller end just large enough to pass the stricture, and the other, 
about two inches in diameter, answers every purpose. It must be held 
by a T bandage, made of gum-elastic, and worn as long, and as fre- 
quently advanced as the patient can well bear ; the rectum should be 
well cleansed with a tepid injection previous to each application of the 
dilator. 

Fissures of the anus are ulcerous grooves in the rectum, extending 
upward from the orifice. The edges of the crack or fissure become 
thickened and hardened, and constantly exude a sanious fluid. These 
should be removed by caustic, as in the case of fistulae, the patient kept 
quiet, the warm relaxant baths employed, and the general regimen strict- 
ly attended to. 

Salivary Fistula. — Wounds of the face, which sever some one of 
the excretory ducts of the salivary glands, are often followed by an ob- 
literation of the cavity of the duct, and the formation of a fistulous 
opening through which the saliva escapes upon the outside of the face. 
The difficulty may be remedied by making an opening with a small 
trochar, passed into the open end of the duct at the fistulous opening, 
and then inserting a gold or silver tube to guide the saliva into the mouth ; 
after which the fistula may be healed by adhesive straps, or these aid- 
ed by the mild caustic. When the injured parts are entirely healed, 
the canula or tube may be removed. 

Fistula Lachrtmalis. — In the true lachrymal fistula the lachry- 
mal sac is distended to a tumor at the inner corner of the eye, which 
ulcerates and forms an opening through which the tears are discharged 
on the face, instead of passing to the nose. There is also a morbid se- 
cretion of the sac distinct from the tears, for which the mild caustic 
mayt>e necessary; and the nasal duct may be »o obstructed as to re- 
quire probing, and the application of a tent. 



ABSCESSES 865 



CHAPTER VI. 



An abscess — aposteme — imposthume — is a collection of purulent mat- 
ter in a cavity, or in the substance of an organ or part of the body. 
Sometimes the pus is contained in an orbicular cavity lined by a cyst, 
and sometimes it is infiltrated into the meshes of the areolar tissue. 
The formation of an abscess is often preceded by chills, or shivering 
fits, called rigors ; and just before suppuration takes place, the pain, 
tension, swelling, throbbing, etc., are increased. After matter is form- 
ed, a sensation of weight and throbbing continues in the part, and a 
conical projection soon denotes the pointing of the abscess, preparatory 
to its bursting and discharging its contents. Some abscesses will point 
in a week ; others may not do so in several months. Generally & fluc- 
tuation may be felt in the swelling previously to its pointing. In order 
to distinguish the fluctuation of an abscess to the best advantage, two or 
three fingers should be placed on one side of the swelling, and the op- 
posite side briskly tapped with the fingers of the other hand. 

Deep-seated abscesses, and those formed beneath fasciae and dense 
fibrous tissues, do not readily point, but they are attended with greater 
constitutional disturbance ; and severer hectic symptoms, as shiverings, 
night-sweats, small, frequent pulse, etc. A sense of weight and cold- 
ness in the part will also succeed the acutely throbbing pain ; and not 
unfrequently the integument over the abscess will become oedematous. 

The general treatment of abscesses is precisely the same as that of 
inflammatory tumors and ulcers, preceding the formation of matter ; 
after which, as a general rule, they are to be opened by cutting or cau- 
terization — usually the former. 

Empyema. — This is a collection of matter in the cavity of the pleu- 
ra. Inflammations of the lungs or of their membranes occasionally re- 
sult in suppuration, producing the abscess under consideration. It is 
known by a manifest enlargement of the side affected ; a dry, tickling 
cough ; laborious breathing, which is easiest in the erect posture ; 
fixed pain in the chest, with difficulty of lying on the sound side. 

Treatment. — In a few instances the matter has worked its way into 
the bronchial tubes and been expectorated, followed by recovery. 



566 SURGERY. 



When any thing is done surgically, it is the operation of paracentesis 
thoracis. An incision is made with the bistoury an inch and a half in 
length, through the integuments, usually at the upper edge, and a little 
behind the middle of the sixth rib ; the intercostal muscles are care- 
fully separated, and the point of the instrument passed in through the 
pleura costalis ; a canula is then introduced, through which the matter 
escapes. Care must be taken that air does not pass in through the 
tube ; to prevent which, the patient may incline, after the introduction 
of the canula, on the affected side; or a valvular instrument may be 
used. This operation has not been generally successful. 

Maxillary Abscess. — This disease is an ulceration of, and collec- 
tion of matter in the antrum of the upper maxillary bone. It is gen- 
erally produced by the irritation of decaying teeth, and may exist for 
years, passing for toothache. It may be known by severe and obsti- 
nate pain in the face just below the prominence of the malar bone ; the 
fetor is also extremely offensive to the patient, and to others about 
him. Sometimes there is a considerable discharge of offensive matter 
from the nose, and in some cases the face is much swelled and disfig- 
ured. 

Treatment. — The inflammation and irritation should be allayed by 
derivative baths and local fomentations. The surgery proper in the 
case consists in extracting the second or third molar tooth, or both ; and 
if the pus does not find a ready exit, a hole is to be drilled through the 
alveolus into the antrum about the size of a goose-quill ; the cavity 
should then be repeatedly washed by injecting warm water ; and if 
the fetor does not soon subside, a few applications of the mild caustic, 
in solution, should be made. 

Mammary Abscess. — Abscess in the breast is sometimes the re- 
sult of injuries, as blows, pressure, etc.; but generally it is the conse- 
quence of bad management or mal-treatment during the periods of ges- 
tation, childbirth, and lactation. The disease usually appears in four or 
five weeks after parturition ; in about ten days thereafter suppuration 
takes place, beginning in several distinct parts, and forming many sep- 
arate sinuses, all of which, however, communicate. It opens at one 
or several points. 

Treatment. — This distressing affection is a standing disgrace to the 
doctor, the nurse, the patient, and all parties concerned. It is produced 
by the most foolish stuffing, and slopping, and stimulating, and heat-, 
ing, and drugging; nor is the usual methrd of doctoring the disease, 
after it has been artificially produced, hnlf ns well calculated to cure the 



ABSCESSES. 367 



malady as to kill the patient. If promptly and properly treated, it can 
almost always be speedily resolved in its early stages. The constitu- 
tional treatment is more important than the local, and both should "be 
managed on the plan heretofore recommended for visceral inflamma- 
tion. The wet-sheet pack, or frequent tepid ablutions, with hip and 
foot-baths, are the general measures ; and the constant application of 
several folds of wet linen, very frequently renewed and well covered, 
is the local appliance. Water may be drank freely, but the diet should 
be rather dry. 

Onyx. — A collection of purulent matter between the laminae of the 
cornea, having the shape of a nail, is so called in surgical technology. 
Its form, however, is nearly semilunar, like the white mark at the root 
of one of the finger nails. It usually occupies the lower edge of the 
cornea, and may be distinguished from kypopyum by its form and situa- 
tion remaining unchanged in all positions of the patient's head. This 
affection can generally be removed by the appropriate remedies to re- 
duce inflammation — on which its existence depends — and promote ab- 
sorption. The head and eye-baths, a moderate douche, and deriva- 
tive, hip, and foot-baths, are all serviceable. 

Lumbar Abscess — Psoas Abscess. — This is one of the most 
formidable and fatal of abscesses. It commences with a dull, heavy 
aching in the lumbar region ; pains shooting down the spine and thighs, 
and a lameness in one or both lower limbs, with a difficulty of standing 
erect; there is usually a drawing up of the testicle of the side more 
particularly affected ; the patient is easily fatigued by exercise, and 
when lying down is disposed to flex the thighs or the abdomen. At 
length the local pain becomes throbbing, chills and night-sweats occur, 
a fluctuating enlargement appears along the psoas muscle, and the apex 
of the tumor presents itself immediately below the groin. The dis- 
ease usually occurs in scrofulous persons, and is often connected with 
caries of the spine, in which case curvature of the spine and paralysis 
of the lower extremities are apt to result. 

Treatment. — If detected in the early or forming stage, this disease 
requires thorough constitutional treatment, of which the pack-sheet 
daily is the leading process. The diet must be strict, the bowels kept 
open by injections, and wet cloths constantly applied to the painful 
part. If the treatment is not commenced early enough to prevent sup- 
puration, the abscess, as soon as fluctuation is clearly detected, should 
be punctured to let out the matter. When the pus lies very deep, an 
epenine may be made fr> it with caustic potash. After the abscess is 



368 SURGERY 

opened, moderate compression should be kept up, and the water-dress 
ing continued. 

Note. — Sometimes the swelling of a lumbar abscess in the bend of the 
groin so nearly resembles that of a hernial protrusion, that great diffi- 
culty is experienced in the diagnosis; and the difficulty is increased by 
the fact that the same impulse is communicated to the swelling when 
the patient coughs in either case. Usually, however, the swelling in 
lumbar abscess is larger and more toward the ilium. In cases of ex- 
treme doubt, a needle may be introduced into the tumor to ascertain the 
character of its contents. 

Hip Disease — Coxarum Morbus. — This disease, like the prece- 
ding, is seldom cured in the regular way. It consists in an abscess 
originating from caries of the head of the os femoris ; it generally occa- 
sions a luxation of the hip joint and a permanent shortening of the limb. 
The symptoms come on insidiously. Generally a slight pain in the 
knee is the first thing noticed. On a close examination the limb will 
be found elongated, which causes the knee to be slightly bent, and the 
whole limb more or less disfigured. At this period the pain will affect 
the groin, and may be severe. Extensive ulceration has generally 
taken place when purulent matter makes its appearance ; this may be 
discharged at several points, although the abscess commonly opens in 
the groin. In some cases the head of the femur is not destroyed, and 
anchylosis results ; but usually the head is dislocated upon the dorsum 
of the ilium, where it may form a new joint, and produce a deformed 
and shortened limb ; when the head is entirely destroyed, the limb 
will be shortened several inches. 

Treatment. — This does not differ essentially from that applicable to 
the preceding disease. When fistulous openings exist, their callous 
edges or fungous growths may require the caustic ; and when they are 
connected, they should, if practicable, be converted into a single one 
by the ligature. In order to enable the patient, during the lengthy 
process of cure, to exercise in the open air, he should be supplied 
with crutches, and the limb should be dressed with gum-shellac, or 
other light splints, to keep the affected joint as motionless as possible. 

Prostatic Abscess. — Abscess of the prostate gland is a result of 
acute inflammation, and may be known by rigors, with swelling, heat, 
and redness of the perineum externally. As soon as matter has formed, 
the abscess must be opened at once, lest the matter work its way into 
the rectum or urethra. 



HERNIA, OR RUPTURES. 



CHAPTER VII. 

, HERNIA, OR RUPTURES. 

The terms hernia and rupture are commonly employed as synony- 
mous ; but writers who are strict in the use of language, apply the 
former word to all protrusions of the viscera or parts from their nat- 
ural cavities, while the latter term is limited to abdominal protrusions. 
The word rupture, however, is always a misnomer, for it implies that 
something is burst or torn, which is not necessarily the case. 

Varieties of Hernia.- — These are innumerable. They may in 
volve the brain, lungs, stomach, intestines, bladder, the different por 
tions of the peritoneum, and in rare cases, the liver, spleen, uterus, or 
ovaries. The parts commonly affected with hernia are the abdominal 
viscera ; of these the intestines, or omentum, or both, are the portions 
usually protruded ; and the abdominal ring, the navel, and a point at 
the inner side of the femoral vein, just below Poupart's ligament, are 
the places where hernia? most frequently appear. They are met with 
occasionally at all points of the linea alba, at the foramen ovale, the 
ischialic notch, in the perineum, and in the vagina. 

Technology of Hernia. — This is derived from their contents and 
locality. A protrusion of the brain is called encephalocele, or hernia 
cerebri; of parts within the thorax, pneumatocele; of the stomach, 
gastrocele ; of the intestine, enterocele ; of the omentum, epiplocele ; 
of both, entero-epiplocele ; of the liver, spleen, bladder, uterus, etc., 
hepatocele, splenocele, cystocele, hysterocele, etc. Abdominal hernia? are 
distinguished according to the aperture from which they escape. AS 
or near the navel they are called umbilical — exomphalos, or empha- 
locele ; through the linea alba above the umbilicus, epigastric ; through 
the linea alba below the umbilicus, hypogastric, infra-umbilical, or 
ceeliocele ; through the abdominal ring, inguinal, or supra-pubian, and 
this variety, when small, is called bubonocele, and in man, oscheocele, or 
scrotal hernia, when the intestine has descended into the scrotum, 
while in woman its extension to the libise is called cpiciocele, or vulvar, 
pudendal, or labial hernia ; through the crural canal,/emoraZ, or mero- 
cele; through the opening which gives passage to the infra-pubian ves- 
sels, infra-pubian ; through the saci >ischiatic notch, ischiatic hernia, 



870 SURGERY. 



through the levator ani, and appearing at the perineum, mesoscelocele, 
or perineocele ; through the parietes of the vagina, coleocele, elylrocele ; 
and through the diaphragm, diaphragmatocele, etc. 

" Ventral hernia" includes all forms of abdominal protrusion, except 
those occurring at the umbilicus, abdominal ring, or femoral sheath. 

In inguinal hernia, the intestine may be arrested in the canal, after 
having passed through the internal abdominal ring, when it is called in- 
complete inguinal hernia ; when it passes through the canal and emerg- 
es at the external abdominal ring, it is called complete inguinal hernia. 
Complete inguinal hernia is called direct, or ventro-inguinal hernia, 
when the bowel passes through the space between Poupait's and Gim- 
bernat's ligaments, leaving the external ring and spermatic eord on the 
outside ; and in other cases it is termed oblique. 

Congenital hernia is the protrusion of some portion of the abdominal 
contents into the tunica vaginalis testis, owing to a want of adhesion be- 
tween its sides after the descent of the testicle. 

Pathological Distinctions. — In abdominal hernia the protruding 
part usually pushes along a portion of peritoneum, which forms a sort 
of pouch, and is called the hernial sac ; the narrow part of which 
is the neck, and the expanded portion the body. The bladder and 
caecum, however, not being contained in the peritoneum, do not have a 
complete sac ; and in cases of wounds and ulcerations, the sac may be 
absent; nor does it exist in internal herniaa, in which there is really no 
protrusion at all. 

In complete or direct inguinal hernia, there are two necks, one at the 
internal and one at the external ring. 

Hernia i« called reducible when the displaced part is attended with 
no disturbance of the general health, and is susceptible of being easily 
replaced ; when incapable of replacement, from its size or from adhe- 
sions, it is called irreducible or incarcerated ; and when the incarce- 
rated part is constricted and inflamed, obstructing the passage of faeces, 
and causing violent pain and sickness, it is called strangulated. 

Special Causes of Hernije. — Surgeons tell us that blows, falls, 
violent exertions, as lifting, wounds, dropsy, abscesses, pregnancy, 
straining at stool, hard riding, and severe coughing, are the common 
exciting causes, while general debility is the general predisposing 
cause. All of these causes are favorable to these complaints, and some 
of them alone produce them; but the general and special cause is cos- 
tiveness. Without this predisponent condition, most of the other causes 
named would be powerless. Many persons, perhaps a majority in re- 



HERNIA, OR RUPTURES. 371 

fined society, scarcely ever go to stool without being obliged to strain 
dangerously, to respond to the " solicitation of nature." And when 
this straining has been kept up for years, it is not remarkable that very 
slight accidents should cause the "bowels to gush out" of their natural 
inclosures in the shape of hernial protrusions. Some have estimated 
the subjects of hernia to be one eighth of an entire population. 

Diagnosis of Hernia. — In a reducible hernia the tumor may ap- 
pear gradually or suddenly at some one of the points above named ; its 
size is changeable, being larger when the patient stands, and smaller 
when he lies on his back ; compression will generally diminish it; it is 
usually more tense after a full meal, or when the patient is flatulent ; 
when the patient coughs, an impulse may be felt at the tumor, as if air 
were blown into the swelling. When the sac contains intestine only, 
the tumor is uniformly smooth and elastic, and also painful to pres- 
sure ; when it contains omentum only, the tumor is insensible, and has 
a more flabby, or doughy, and somewhat unequal feel; and when it 
contains both — entero-cpiplocele — a part of the contents of the hernial 
tumor will slip up with a gurgling noise, leaving behind a portion less 
readily reduced. 

Irreducible hernia; are distinguished by more or less difficulty in 
evacuating the bowels ; colic pains are frequent, with a variety of dys- 
peptic, symptoms. They do not usually occasion great inability or in- 
convenience, but are liable to intussusception — a slipping of one portion 
of bowel into another — and this is a dangerous and often fatal ac- 
cident. 

Strangulated hernia presents, first, an irritable condition of the parts 
affected, with a hectic flush externally, and a pain at the point of con- 
striction; the pain generally extends to the diaphragm, followed by 
nausea, vomiting, obstinate constipation, rapid pulse, and general fever- 
ishness. The peristaltic action is often inverted, and faecal matters are 
ejected from the stomach. If reduction is not soon effected, the bow- 
els become distended with air, the abdomen hard and tense, the ex- 
tremities cold, while hiccough, clammy sweats, and a sinking pulse, 
with a sudden cessation of the pain, denote the existence of mortifica- 
tion, and the approach of death. 

General Treatment of Hernia. —When the hernia is reduci- 
Jle, the protruded part is to be returned to its natural position, and 
maintained there by a truss, or other suitable contrivance. In some 
rare cases, however, the contents of the hernia are so bulky, or the 
parts so altered, that it is advisable merely to support the tumor with a 



372 SURGERY. 



suspensory bandage, unless an attempt at a radical cure should be 
deemed expedient. 

In irreducible cases the strictest attention must be paid to the diet, 
which should be so managed as to obviate the least tendency to con- 
stipation. With this precaution, the use of a truss or bandage, and the 
avoidance of all rough exercises, the patient may " live through life" 
very comfortably. 

But when the reducible variety suddenly becomes incarcerated, and 
in all cases of strangulation, the first attempt at relief should be by the 
taxis, or hand operation. The taxis can almost always be successfully 
performed by any one who has a clear idea of the mechanism of the 
part and the existing obstacles. 

The patient is to be placed in a horizontal posture on the sound 
side — these directions apply particularly to inguinal and femoral her- 
nia, other varieties not requiring special instructions — with the hips 
elevated, the chest inclined forward, the thigh of the affected side flexed 
upon the abdomen, and drawn toward the other — all of which is intend- 
ed to relax the muscles and integument at and around the protrusion. 
The sac is then to be gently grasped, and moderately elevated and com- 
pressed with one hand, while the forefinger of the other hand presses 
as much of the tumor as possible up to and within the point of protru- 
sion ; the returned portion is to be retained while the middle finger 
pushes up another portion, when the forefinger may be again em- 
ployed for still another portion; the middle finger holding the part il 
has brought up, or the ring finger may be used, while the others are 
both occupied in holding the advantage gained. In this way the whole 
tumor is to be removed. 

In the external inguinal hernia, the pressure must be directed up- 
ward and outward, along the course of the spermatic cord; butinyew- 
oral hernia it is to be directed first downward, and then backward. In 
umbilical and ventral hernia the pressure is to be made directly back- 
ward. Violence must never be used, nor the parts handled so roughly 
as to occasion much pain. 

Several circumstances, however, may interfere with the operation 
of taxis, or defeat its successful result, as extreme distention of the pro- 
truded intestine, great pain and tenderness, active inflammation, severe 
constriction around the neck of the sac, etc. ; but these things should not 
discourage us. We have in cold water or ice a suitable auxiliary for 
the first-named complication ; its assistance will often enafcle us to suc- 
ceed at once. When the part is excessively tendor and irritable, hot 
water must be brought in requisition. The full warm bath, or local fo- 
mentations, or both, may be employed, and theso may be followed by 



HERNIA, OR RUPTURES. 378 

a reapplication of the cold process. Our "old school" friends, on their 
characteristic principle, that when a patient is suffering locally, he ought 
also to be made to suffer constitutionally, recommend tartar emetic and 
bleeding to produce sickness and faintness, with a view of bringing 
about relaxation and quietude ; but warm water externally, and inter- 
nally by injection, may be made to produce any degree of these effects 
which can be desired. After the employment of either of these water 
processes, the taxis is to be tried again. 

There is yet another resource in bad cases — dry-cupping — which 
Dr. Hill {Eclectic Surgery) significantly calls traction from within, and 
which is not mentioned in any other work with which I am acquainted. 
A large cup, or any convenient vessel, may be applied to the abdomen, 
covering the umbilical region, in which a piece of burning cotton is placed 
to exhaust the air ; the " suction" thus established will pull upon the 
protruded intestine while we may be pushing from without. Holding 
the patient's heels up, and head down, and jounciug him in that condi- 
tion, has succeeded in "domestic practice," in reducing a rupture, of 
which Dr. Hill gives a notable instance. 

In extreme cases, when the strangulation with inflammation has ex- 
isted, despite the efforts to reduce it, for twelve or fifteen hours, the 
only chance for the patient is by the operation with the knife ; yet this 
does not afford him quite an equal chance to live. It consists in making 
an incision through the skin three or four inches in length, along the 
course of the tumor, cutting through the successive layers — described 
in the first part of this work under the head of " Anatomy of Hernia" — 
or coverings, by picking up a small bit at a time with the forceps and cut- 
ting horizontally through it under their points, until an opening into the 
sac — which can be distinguished by its bluish appearance — is made. 
"The sac" — I quote substantially from Dr. Hill — •« is then opened in the 
same manner, and the small director, fig. 202, inserted, and an opening 



Fig. 202. 




THE SMALL DIRECTOR. 



made large enough to admit a finger. The forefinger of the left hand is 
32 



374 



SURGERY. 



w,rt 'introduced, fig. 203, and passed up to the neck of the sac to find 

Fig. 203. 



f *** 



Vx 




OPERATION FOR STRANGULATED HFRNIA. 

the Stricture, which may be at the internal or external ring, or at both 
places; the stricture should be sufficiently dilated to permit the finger 
to enter the abdomen ; this may be done by the probe-pointed bistoury, 
or similar knife, made for the purpose, not edged quite up to the point, 
nor but a short space below it, fig. 204. The blade is passed up flat- 
Fig. 204. 




HERNIAL BISTOURY. 



wise, along the finger, and pushed on through the stricture. Its edge 



Fig. 205. 




CUTTING THE STRICTURE. 



is then turned up- 
ward, cutting no more 
tlinii necessary to ad- 
mit the finger, figure 
205. The cut must 
always be made di- 
rectly upward, paral- 
lel to the linea alba, 
to avoid the epigas- 
tric artery. After 



HERNIA, OR RUPTURES. 875 

the stricture is thus relieved, the parts must be examined, and if firm 
adhesions have taken place, or fatty deposits accumulated largely, no 
attempt at reduction must be made, but the wound allowed to heal. 
When mortification has taken place, the only chance is by an artificia. 
anus. In femoral or crural hernia, the sac is usually very small, and 
embraces the bowel very tightly ; hence it must be opened with 
caution. 

Rvdical Cure of Hernia. — Beyond the taxis for reducing dis- 
placement, and the operation for relieving strangulation, little or nothing 
has been done for this class of invalids in the way of regular surgery, 
while mechanical skill has generally been content to prevent further 
mischief by the constant application of a truss. But it has been no- 
ticed that in recent cases the pressure of a truss has sometimes excited 
adhesive inflammation in the parieties of the canal between the ab- 
dominal rings, or in the femoral sheath, and thus closed the passage 
against all future danger. Acting on this hint, others have succeeded 
in some recent cases, by keeping up as strong pressure as the patient 
could bear, by means of a truss with a large and hard pad, so applied 
as to compress the whole canal or sheath through which the viscera 
had passed. Others have succeeded in cases of long standing, by add- 
ing to the mechanical-pressure treatment, that of vital irritation, the 
combined effect of both being to produce the requisite degree of ad- 
hesive inflammation to obliterate the canal, sheath, or cavity, where 
the rupture presents. Professors Morrow and Hill, of Ohio, umploy 
an irritating-plaster — compounded of bloodroot, mandrake, wake- 
robbin, pokeroot, tar and rosin — large enough to cover the whole canal 
or sheath — two to two and a half by three to three and a half inches — 
over which the truss is worn, the pad of which is nearly as large as 
the plaster. The part is first shaved, the plaster applied, and then the 
truss is adjusted as tightly as the patient can bear, the compression 
being diminished as the parts grow tender. The truss is removed 
daily, and the plaster re-spread, during which the patient must keep 
perfectly still in the horizontal posture, with the thighs flexed upon 
the abdomen. When the truss cannot be longer borne on account of 
the pain, it is substituted by a compress and bandages ; and while these 
are worn the patient is recommended to keep on his back. A point 
of practice especially insisted on is, that no protrusion must on any 
account be allowed to take place during the treatment. Should the 
pain and irritation become intolerable, the plaster is to be omitted for a 
few days, a slippery elm poultice taking its place ; and this the hydro- 
path could readily supersede by simple flour to the surface, over which 



»7fe SURGERY. 



warm wet cloths might be applied. It is contemplated, by this plan of 
treatment, to excite a purulent discharge from the surface covered by 
the plaster, and eep up the suppuration from four to six weeks. 

The principle upon which this cure is predicated is clearly correct ; 
and a score of physicians, all understanding the principle, might find a 
score of ways to apply it successfully. It can matter but little what 
the irritants are, provided they produce precisely the proper degree 
of irritation, and do not poison the system from absorption. An as- 
tringent plaster, made of the extracts of hemlock, white oak, green 
ozier, and the common or rock break, with the occasional application 
of a few drops of oil of eggs, in combination with the pad and truss, 
constituted the empirical but rather successful plan of Hurlbutt's 
treatment of hernia, for which he obtained a patent. 

Umbilical and Ventral Hernije. — Infants are most subject to 
umbilical hernia; the protrusion is generally imputed to straining while 
crying, when the abdominal bandage which is placed around the body 
is too loose. This is one among many great errors which have crept into 
professional men's minds. The truth is, that this bandaging the body 
is just what produces the rupture in a large proportion of cases. It is 
this that makes the child cry and strain ; and the tighter the abused 
infant is girded with it, the more it will cry and strain, and the more 
liable it. will be to have a rupture. It sometimes occurs in parturient 
females from the muscles giving way during the powerful contractions 
upon the gravid uterus. 

Treatment. — The protruded portion of bowel can generally be re- 
duced very easily by the hand, after placing the patient on the back, 
with the shoulders moderately elevated, and the thighs flexed upon the 
abdomen. A sufficient degree of adhesive inflammation to effect a 
radical cure may be excited by k modification of the plan proposed for 
Ihe preceding varieties. A much less amount of external irritation 
will usually answer the purpose, and the pad of the truss, by which 
the compression is made, must be so adjusted that the pressure will 
keep the sides of the aperture constantly in contact. Dr. Hill gives 
the following directions for the mechanical treatment, which I copy as 
the best extant: "Take a circular piece of the thick spongy portion of 
sole leather, of the proper size to cover the opening, and extend from 
one and a half to two inches all around it. Excavate the fleshy side of 
the leather, so a3 to make it regularly concave, the center of the de- 
pression being about half an inch below the plane of the circumfer- 
ence. Place the patient in the position for reduction, and bring the 
parieties of the hole in the muscles in contact, so as completely to 



DEFORMITIES. 377 



close the orifice, by pressing from the sides, while the muscles are in 
this relaxed condition. The edges being thus kept in contact, apply, 
directly over the point of protrusion, a layer of raw cotton or soft lint, 
wet in a strong decoction of white-oak bark. This application should 
be just large and thick enough to fill the excavated surface in the 
leather, without causing any pressure. Apply your leather pad over 
it, and secure it by a bandage passed round the body, sufficiently tight 
to compress the muscles, and keep in contact the parieties of the aper- 
ture. It is better to fasten the pad to the bandage before it is applied. 
This should be kept on six or eight days without being removed, unless 
it produce too much irritation. It should be wet once or twice a day 
with the oak decoction, by applying it upon the surface and allowing it 
to soak through the pad and cotton." One or two weeks will 
often suffice to produce adhesion in an infant, while an adult may 
require the treatment for one or two months. While removing the 
dressings the patient must be placed in the position before described, 
and the walls of the abdomen firmly held by an assistant, so that no 
motion be allowed to interrupt the adhesive process. 



CHAPTER VIII. 

DEFORMITIES. 



The deformities which result from accident, disease, or malconforma- 
tion, are innumerable ; but an understanding of the principles which 
apply to the management of those which are common, will readily 
suggest the modifications applicable to unusual cases. 

Hare-Lip — Labium Leporinum. — This is a fissure in the upper 
lip, which may be single or double. In the F 'g- 206 - 

former case it is usually on one side of the 
mesial line ; in the latter each fissure ex- 
tends downward and outward from one of 
the nostrils, as in fig. 206. In some cases 
the division extends backward through the 
palate bone, and often the front teeth pro- 
ject through the fissure, adding greatly to 
the deformity. double hare-lip. 

Treatment. — The operation of tying by the twisted suture is the 




378 SURGERY. 

only remedy. The edges of the fissure are raised with the fingers or 
forceps ; a flat piece of wood is placed between the lip and gum ; and 
the edges are then pared off from both sides upon the wood with a 
scalpel or bistoury, leaving the edges straight like the shape of the let- 
ter V. The bleeding can be stopped by sponging with cold water, 
after which a th!'n sewing needle is passed through and across the fis- 
sure near its lower extremity ; the needle must penetrate nearly to the 
inner surface of the lip, which will keep the inner edge together while 
the ligature secures the outer edge. After this needle is secured by 
the thread two others are to be introduced above at proper distances, 
and the part dressed with wet lint, over which a bandage is applied, 
and kept constantly wet with cold water. Adhesion will take place in 
about a week, during which time the patient must be kept very quiet; 
after this time the needles may be removed and adhesive straps ap- 
plied. When two fissures exist each is to be treated in the same way, 
and both should be operated upon at the same time. When projecting 
teeth are in the way they should be extracted. 

Tied Tongue. — Notwithstanding I have had some fifty applications 
to cut babies' tongues, I have never yet seen a case of this kind. It is 
an extremely rare occurrence in reality, though very apt to exist in 
the imagination of nurses. When the frenum lingua is extended to 
the tip of the tongue, firmly holding this "unruly" member to the 
floor of the mouth, and preventing the child from sucking, it is a 
tongue-lie ; and then the surgeon may elevate the member with one 
or two fingers, and snip the string across as near the floor of the mouth 
as possible, with a pair of scissors. The cut should rarely extend be- 
yond one eighth of an inch. 

Enlarged Tonsils and Uvula. — These are rather inconveniences 
than deformities ; yet it is sometimes advisable to excise them. The 
proper instrument for doing this, fig. 207, has an angular or rounded 

Fig. 207. 




INSTRUMENT FOR EXCISING THE TONSILS AND UVULA. 

blade, which can be drawn back, leaving a ring to be passed over the 
part to be removed, after which the blade, armed with a needle to 
prevent the excised portion falling into the throat, is pushed forward 
against the tumor. 



DEFORMITIES. 



879 



Squinting — Strabismus. — In the majority of cases of permanent 
Bquinting, the difficulty is owing to a disproportionate contraction in the 
recti muscles, one being too much relaxed and the other preternatu- 
rally contracted. The remedy consists in a division of the contracted 
muscle, and this is usually the internal rectus. The eye is secured 
and held by the wire-spring speculum, fig. 208 ; a double-hook is then 



Fig. 208. 




Fig. 209. 



SPECULUM APPLIED TO THE EYE. 

hitched to the conjunctiva midway between the margin of the cornea 
am" internal canthus, by which the ball is rolled outward, as represented 
in fig. 209, and the handle then held by an assistant. The operator 
next raises the conjunctiva with 
fine hook-forceps, cuts into it per- 
pendicularly with the curved scis- 
sors, and continues to raise and di- 
vide the cellular tissue until he 
reaches the muscle, when he sev- 
ers it with the scissors. 

If the muscle has been com- 
pletely divided, the patient, on hav- 
ing the eye released, will be able 
to turn it in all directions, except 
directly inward. After the opera- 

, „ t n k„ t„r>f OPERATION FOR STRABISMUS. 

tion, the eye requires to be kept 
covered for a day or two with a wet cloth. 

Superfluous Fingers and Toes. — Supernumerary appendages to 
the hands and feet are not of much consequence ; but as they are not 
usually attached by a regular joint, they may readily be got rid of by 
means of the ligature or knife. 




Web Fingers. — These only require division by the scalpel, and to 



880 



SURGERY. 



be prevented from reuniting by a piece of oiled silk kept between the 
fingers until cicatrization takes place. 



We y Neck. — If this deformity is so great as to render an operation 
desirable, the constricting muscular tendon or fascia is to be divided 
with the knife. The incision should be as superficial as possible; when 
the muscle has been completely divided, it will snap back. The hemor- 
rhage can be prevented by the ordinary compress. 

Spina Bifida — Hydro-Rachitis. — There is & possibility of curing 
some cases in which the membranous covering is rather thick and firm, 
by means of a linen compress and bandage, applied moderately tight, and 
so adjusted as to press the tumor down to a level with the surface. If 
inflammation exists, the cold water-dressings must be added. 

Spinal Curvatures. — These deformities, which have been con- 
sidered in the preceding part of this work, are rather medical than sur- 
gical maladies; and the subject is only introduced here to add an ocular 
demonstration of the theory advanced in relation \,o their pre isposing 
and proximate causes. Fig. 210 is a representation of a single curva- 

Fig. 211. 



Fig. 210. 




MJSPOS1YION AT WORK. 




DOUBLE CURVATURE. 



DEFORMITIES. 



881 



ture in its forming stage, occasioned by a habitually-improper position at 
a work-table, which is raised too high. Those who have a clear idea 
of the manner in which these ailments originate, will at once appreciate 
the absurdity of the ordinary treatment with mechanical machinery and 
surgical cauterization, by which many poor backs have been cruelly 
tortured and many bodies permanently crippled. An extreme result 
of the same cause is seen in the curvature, fig. 211. 

Scrofulous persons, from their greater frailty or laxity of organiza- 
tion, are peculiarly liable to lateral curvatures, when exposed to any 
causes which debilitate the muscular system, or throw the different 
sets of muscles out of balance. 

In double curvatures the misposition of body is generally connected 
with causes which tend especially to debilitate the abdominal muscles, 
as constipation, hot drinks, feather beds, etc. 

Mercurialized Tongue. — This is both a cruel disease and a hor- 
rid deformity, as the accompanying representation will bear witness, 
fig. 212, and I introduce the subject in this place for the especial pur- 
Fig. 2ia 




SALIVATION 



382 3 U It G E R Y. 



poses of protesting against its cause, and against the treatment which 
those physicians whose "healing art" creates the disease, recom- 
mended to cure it. This treatment consists in making long and deep 
incisions into the tongue with a scalpel. It is not strange that those 
practioners, whose " remedies" produce such consequences, should be 
the poorest doctors in the world when those consequences themselves 
require medication. Nothing will reduce this violent mercurial inflam- 
mation equal to the wet-sheet pack ; so managed as to produce mod- 
erate but frequent perspiration. At the same time the bowels must 
be kept very free with tepid injections, the wet compress applied to the 
neck, the mouth frequently rinsed with cool but not very cold water, 
and sips of cool or cold water — as either is most agreeable to the patient 
— swallowed whenever the patient has the ability to swallow. When 
the body is extremely sensitive to cold, a tepid ablution, followed by the 
dry pack, is the best way to promote a perspirable condition of the skin, 
and this may be frequently repeated. 

Professor Chapman, in a text-book for medical schools (Materia 
Medico), tells us that " Occasionally mercury, from some unaccounta- 
ble cause, instead of operating as a remedy, acts as a poison ;" and Dr. 
Thacher, author of two standard works (American Practice of Medi- 
cine, and American New Dispensatory), informs us that " no rules can 
be given or regarded to regulate its administration" or obviate the un- 
certainty always attending its introduction into the human stomach; 
and surely such authorities sufficiently sustain the protest here entered 
against destroying any more tongues, teeth, gums, palates, jaws, and 
lips — I have seen one case in which both lips were eaten off by a mer- 
curial action — and ruining any more constitutions by this Paracelsian 
quackery. 

Pseudarthrosis. — This is an unnatural or false joint, resulting from 
a failure of the portions of a fractured bone to unite by ossification or 
callus ; it may be caused by morbid habit of body, or the fault may 
arise from the fractured bones not being properly brought into contact. 
A ligamentous capsule forms around the extremities of the broken 
bones, which finally become smooth and round ; and in some cases a 
regular ball-and-socket joint is formed. The most hopeful plan of 
treatment is to pass a seaton-needle, armed with a skein of silk, through 
the limb between the ends of the bones, by means of which a running 
sore may be kept up for six or twelve months, and possibly adhesive in- 
flammation excited and a re-union produced. 

Club-Foot — Talipes. — Surgeons distinguish four varieties of this 



DEFORMITIES. 



383 



deformity. In the first — talipes varus — fig. 213, the foot is turned 

Fig. 213. Fig. 214. 




TALIPES VARUS. TALIPES EQUIPTAS. 

inward, the patient walking on the outside of it, the heel being el- 
evated. In the second variety f ig 215 
— talipes equinas — fig. 214, the 
heel is- more or less elevated, the 
patient walking on the ball of 
the foot or on the toes, and pres- 
sing equally on all the toes, or 
principally on the side of the lit- 
tle, or that of the great toe. In 
the third — talipes vulgus — the 
foot is turned out so that the 
patient walks on the inner sur- 
face, the external edge being 
raised from the ground, and the 
sole standing outward ; and in 
the fourth — talipes calcaneus — 
fig. 215, the toes and foot are 
elevated to an acute angle with 
the leg, the heel resting on the 
ground. 

Causes. — The first variety is 
produced by a contraction of the 

TALIPES CALCANEUS 




rf84 SURGERY. 



muscles of the calf of the leg and the adductors of the foot; file sec- 
ond variety is usually owing to a contraction of the gastrocnemii mus- 
cles alone, but sometimes the flexors of the toes are also contracted ; 
the third variety is # caused by the contraction of the adductor muscles, 
and also those of the calf of the leg ; and the fourth variety is owing 
to the contraction of the tibialis anticus and the extensor muscles. 
These deformities are usually congenital, but may result from acci- 
dents. 

Treatment. — The majority of cases can be remedied by proper me- 
chanical apparatus, if it is applied early — say before three years of age. 
A variety of machines are in use, and the skill of the surgeon is re- 
quired to adapt one to each particular case. They consist essentially 
of a stiff shoe or sole, fixed to an upright shaft, to which springs are so 
attached as to make gentle but constant extension against the contracted 
muscles. Where machinery fails, or is not applicable, the operation of 
tenotomy — a division of the contracted tendon or tendons — is the only 
chance. A division of the tendo achillis is sufficient in a majority of 
cases of the first variety. The skin is drawn tense so that it will cover 
the wound when it contracts, and a long, narrow-bladed knife is passed 
through the skin flatwise between the tendon and the bone, near the 
anterior surface of the tendon, one or two inches above the internal 
malleolus, and carried through to the skin on the opposite side ; the 
edge is then turned upon the tendon, and while an assistant bends tho 
foot so to put the tendon firmly on the stretch, this is cut through, when 
it will separate with a crackling noise. The limb is kept in an easy po- 
sition for three or four days, and then placed in a suitable machine to 
keep up extension and fix it in its proper situation. 

The posterior tibial muscle can be most readily divided about two 
inches behind and above the internal malleolus ; the anterior tibial, 
where it passes over the ankle joint ; and the flexor of the great toe on 
the sole of the foot, where it may be seen and felt projecting like a 
strong cord. 

Contracted Sinews. — A contraction of the flexors of any part of 
the body is so termed. It is most frequently seen in the fingers or 
toes over -riding each other. The fingers are also contracted from in- 
flammation, and a "club-hand" is sometimes met with. Some of the 
cases may be relieved by an incision through the skin ; but others re- 
quire the operation of dividing the tendon or muscle affected — tenotomy 
or myotomy. 



DISLOCATIONS. 886 



CHAPTER IX. 

DISLOCATIONS. 



Technology/. — A displacement of one bone from its natural articu- 
lation with another is called a simple dislocation, when unaccompanied 
with exfernal laceration or fracture ; and compound and complicated, 
when those conditions co-exist. Its readjustment is termed reduction. 
The mechanical means employed in reduction are extension — the force 
applied by the surgeon on the luxated part ; and counter-extension — the 
force employed to fix the body in position, which may be by machinery, 
such as pulleys, or by the hands of assistants. Dislocations are called 
partial when the bone is moved out of position in its socket, or on its 
articular surface, without being thrown completely out or off. 

"Symptoms. — A dislocation is known by a change in the external 
form of the joint; an alteration in the length of the limb; the altered 
axis or position of the limb. The patient may have the power to move 
the limb immediately after the accident. When considerable swelling 
has taken place, it is often extremely difficult to distinguish between a 
dislocation and a fracture near the joint. When muscles are ruptured, 
there is great effusion and inflammation in the part. 

Treatment. — The principal obstacle in the way of reduction is the 
contraction of the muscles ; and this difficulty increases with the length 
of time the part has been displaced. When luxation has existed for 
several weeks, adhesions are apt to occur, forming a new joint or an 
anchylosis, and rendering reduction impossible without a new disloca- 
tion, and doubtful with. 

Very soon after the accident the displaced bone can generally be 
replaced with very little force. But when the muscular contraction is 
strong, we must employ, in addition to extension and counter- extension, 
warm water to the part to relax the muscles particulai'ly implicated ; 
and in severe cases, the full warm-bath, to relax the whole muscular 
system ; and in extreme cases, the patient must also drink plentifully 
of warm water, and have the throat frequently tickled, to excite and 
maintain considerable nausea. The extending force should always be- 
gin gently, and be gradually increased, while the counter-extension 
should, of course, be fixed and uniform. The limb should be slightly 
flexed, so as to favor relaxation. In dislocations of the shoulder, the 
II— 33 



880* SURGERY. 



extension bandage should be applied to the forearm ; and in disloca- 
tions of the hip, above the knee. As the patient's mind, directed to 
the injury or operation, increases the contractility of the muscles, 
adroit surgeons often contrive some way of diverting it, at the moment 
when extension 1ms been carried to a sufficient extent, as by smashing 
a window, communicating tidings of some awful accident, etc. When 
the bone returns to its socket, a " snap," like that of a lock when the 
key is turned, can be heard, and generally felt. The after-treatment 
is simply a bandage wet with cold water for a few days. 

There is a general plan by which many, perhaps a majority, of dia 
locations, can be replaced by persons entirely ignorant of anatomy 
This consists in drawing the limb out of place as much as possible, in 
(he first place — that is, extending it, and then, while the patient's mind 
is diverted to something else, making a sudden rotary motion, during 
which the bone generally slips into its place. Many marvelous stories 
have been told of Dr, Sweet and other " natural bone-setters," who 
have frequently succeeded by this method, after the scientific surgeon 
had failed ; they were called natural bone-setters, because they were 
not professionally educated. 

The following remarks of Mr. Skey, on "The Reduction of Disloca- 
tions Generally," are exceedingly valuable : 

" In the endeavor to reduce a dislocation, the line of traction should 
hold reference less to that of the socket, or surface from which the 
>one has been displaced, than to the more important purpose of easing 
it from the surface, on which it has lodged. For example, the rim of 
the glenoid cavity, in dislocation of the humerus, presents an obstacle 
to the extension of the bone in the immediate line of that cavity ; but 
if the bone be drawn off it by extension made in any oblique direction, 
the instant this ridge is passed, the head will rush back into its natural 
cavity. So, also, in dislocation of- the femur on the dorsum illi, we do 
not attempt to draw the bone in a direct line with the acetabulum, but 
we carry it below, round its back and elevated margin, and no sooner 
does it reach the lower part of the rim, which is much less prominent 
than the upper and back part, than the muscles immediately restore it 
to its socket. The same rule holds in dislocation of the ulna and radius 
backward at the elbow-joint. I believe the exact line of extension to 
be much more readily determined, and, in truth, a less important sub- 
ject of consideration, than it is generally deemed. I believe that if we 
bring the bone sufficiently downward, and place it in the neighborhood 
of the articulation, the muscles will replace it with as much ease as 
that which originally dislocated it. 

" The bone appears, as it were, sucked violently into the socket, oven 



DISLOCATIONS. 



387 



at the instant of its sustaining the greatest force of extension. Then 
is it that the muscles, acting with one accord, set at naught the extend- 
ing power, and complete the work of reduction, in defiance of all the 
agents employed at the moment to" prevent it. I consider that the 
muscles are the immediate agents of reduction, and not the surgeon, 
whose entire duty consists in placing the bone in a position to give them 
the opportunity of displaying this harmony of action, and* of exercising 
a power, even beyond that of the mechanical agents of extension. It 
is this power that succeeds in forcibly drawing backward the head of 
the femur into its cavity, when it has faiily reached the rim of the ace- 
tabulum, notwithstanding the force employed at that instant in extend- 
ing it. In the examples of the larger dislocations, I place no reliance on 
any of the above-mentioned efforts of manipulation, but depend almost 
entirely on the act of simple extension, in the fullest confidence of the 
disposition of the joint to right itself if the obstacles be removed." 



Dislocation of the Jaw. — 
gaping, or from a blow on the 



This accident arises from yawning or 

Fig. 216. 



chin when the mouth is wide 
open. It may affect one or both 
sides. Fig. 216 represents the 
appearance of the mouth in a 
dislocation of both articulations. 
The mouth remains wide open, 
the saliva runs constantly, and 
there is often alarming but not 
dangerous pain. 

Treatment. — The reduction is 
easily affected. Place two pieces 
of soft wood, or large corks, as 
far back between the teeth as 
possible, to act as fulcrums ; then, 
while the head is held by an as- 
sistant, press the chin steadily 
upward and backward. 

Another method is : place the 
thumbs on the back teeth, and 
the palms of the hands and fin- 
gers on the sides and under sur- 
face of the jaw; then press downward with the thumbs, and forward 
and upward with the hands ; the thumbs must be removed as the joint 
slips in its place. 




DISLOCATION OF THE JAW. 



3 U R G E R Y. 



Dislocation of the Clavicle 

Fig. 217. 




■ CLAVICULO-STERNAL DISLOCATION. 

outward, the collar-bone is drawn 
down to a level with the breast- 
bone, when the head will readily 
fall into its proper place. 

To retain it in position, sur- 

Fig. 218. 



,— The collar-bone may be dis- 
placed at its sternal or scapular 
extremity ; in the former case it 
is pushed foiward or backward, 
and in the latter generally up- 
ward. Fig. 217 shows its situa- 
tion when dislocated at the breast- 
bone. In thin persons the nature 
of the injury is obvious at a glance ; 
but with very fleshy individuals 
the diagnosis is sometimes diffi- 
cult. Moving the shoulder, how- 
ever, occasions great pain ; and it 
is with much difficulty that the 
patient can move it at all. 

Treatment. — By pulling the 
shoulder backward and slightly 
Fig. 219. 




CLAVICLE BANDAGE BEHIND. 



CLAVICLE BANDAGE ANTERIORLY. 



geons have a clavicle bandage, which is buckled round the body and 
found the shoulders with a soft pad in each armpit, and another on 



DISLOCATIONS. 



389 



each shoulder. It is applied in different modes by surgeons, and in- 
closes the arm, as it were, in a sling. A back view of it is seen in fig. 
218, and a front view in fig. 219, which will enable any person of ordi- 
nary tact to adjust it successfully. The arm is previously supported in 
a sling. 

When the scapular end is dislocated, the shoulder on the injured 
side is depressed, as compared with the other, and also draxon inward 
toward the sternum. In reducing it, the surgeon, standing behind the 
patient, places his knee between the shoulders, and draws them both 
backward, until the clavicle sinks into its place. The arm-sling and 
clavicle bandage are so applied as to keep the arm pressing slightly up- 
ward and backward. Some degree of deformity will always exist after 
these accidents. 



Dislocations at the Shoulder- J oint. — The head of the hu- 
merus may be displaced downward into the axilla, forward under 
the clavicle, backward upon the dorsum of the scapula, and partially 
luxated upward against the outer side of the coracoid process. 

Symptoms. — In the downward luxation, fig. 220, the head of the bone 
is readily found in the axilla, or Fig 220. 

resting on the lower side of the in- 
ferior costa of the scapula ; there 
is a tumor-like projection in the 
armpit, and a corresponding hol- 
low below the acromion process. 
The whole form of the shoulder is 
changed, the muscles being flat- 
tened, and the arm seemingly elon- 
gated ; the elbow cannot be brought 
to the patient's side without great 
riain, and the patient inclines to sep- 
arate his arm from the body and 
support it with the other hand. 
When the accident has existed for 
a considerable time, an effusion of 
lymph into the joint may occasion 
a crepitus on moving the arm, 
something like the grating sound of a fracture. In the forward luxa- 
tion, fig. 221, the head of the humerus can be plainly felt, and gen- 
eralty" seen upon the pectoral muscle below the clavicle. The point 
of the acromion process is very distinct, and beneath it is a considera- 
ble hollow. The coracoid process is on 'he outside of the displaced 




DOWNWARD LUXATION. 



890 



SURGERY. 



head, which, when the arm is rotated, can be observed to move. The 
elbow is thrown further back than in the downward luxation, the arm 
is much shortened, and there is great difficulty in moving the arm in 
any direction. 

In the backward luxation, fig. 222, the projection of the head of the 
Fig. 231. Fig. 221 




FORWARD LUXATION. BACKWARD LUXATION. 

bono is apparent at first sight, and when the elbow is rotated it is seen 
to move. It may also be felt by applying the finger just below thfi 

Fig. 223. 




REDUCTION OF AXILLARY LUXATIONS. 



DISLOCATIONS. 



891 



spine of the scapula, and the change in the axis of the limb is quite ob- 
vious. This variety of dislocation is extremely rare. 

Treatment. — The general plan of reducing luxations at the shoulder 
joint, adopted by modern surgeons, is represented in fig. 223. The 
patient is placed in a recumbent position, and the surgeon, sitting be- 
fore him, puts his unshod heel on the head of the bone in the axilla, 
and presses it upward, while he pulls steadily and firmly on the arm, 
until the head of the bone slips into the glenoid cavity. By this simple 
management, almost any person, although entirely ignorant of anat- 
omy, may reduce nearly all the luxations that occur at this joint, by 
taking the case very soon after the accident. If greater force is re- 
quired than one person can exert, he may be assisted by others pulling 
behind him, by means of additional straps or bandages placed upon the 
arm. If this plan fails, greater force can be brought to bear by the 
method represented in fig. 224. The patient is seated in a chair, and 




EXTENSION AND COUNTER-EXTENSION. 

counter-extending bandages so applied as to let the arm pass through 
them. For the extending bandage, a wetted roller, placed around the 
arm above the elbow, with straps or slips of cloth attached, will answer 
The arm is then raised so that the elbow is a little above the horizon- 
tal line with the shoulder, and, while in this position, two or more as- 
sistants make gradual and steady extension upon it, an equal amount 



892 



SURGERY. 



of force being employed in producing counter-extension at the same 
time. After the strain upon the muscles has been continued for some 
time, the surgeon, restiDg his foot on the chair, pushes his knee into 
the axilla and presses up the head of the bone, while he presses down 
on the acromion with one hand ; making also slight rotation upon the 
arm. 

There is another method by which a majority of recent dislocations 
can be easily replaced without waiting for the regular surgeon. Placs 
the patient in a chair, fig. 225, extend the luxated arm as far as posss 




REDUCTION OF RECENT LUXATIONS. 

ble from the side, then, with the knee in the axilla — the foot being sup 
ported on a chair, and the heel raised so as to press the knee upward 
— grasp the humerus above the elbow with the hand, pressing down 
upon the shoulder at the same time. The pulley and counter-extend- 
ing bandage, seen in the cut,*may also be employed if necessary. 

In the forward luxation, the extension is to be made obliquely down- 
ward and slightly backward. The resistance is usually stronger than 
in axillary dislocations ; hence- extension must be kept up somewhat 
longer. When the head of the bone i3 observed to move, the surgeon 
should place his knee or heel against it, and press it backward into ita 
cavity. In other respects the management is the same as for tha pre- 
ceding variety. 



DISLOCATIONS. 



393 



In the backward luxation the reduction is easy. After the shoulder 
is fixed, gradual extension is made directly outward, the head of the 
bone being thus moved slowly forward into the glenoid cavity. This 
dislocation has been replaced by merely raising the arm, and turning 
the hand to the back of the head. 

After reduction, the arm should be carried in a sling for several 
days, and all motion at the joint prevented by suitable bandages. 



Dislocations at the Elbow. — Injuries at this joint are very fre- 
quently complications of dislocation, fracture, and laceration. Sur- 
geons distinguish five varieties of dislocation. Both bones of the fore- 
arm may be pushed backward, or to one side ; the radius may be dis- 
placed forward; the ulna alone may slip backward over the condyle of 
the humerus ; and the radius alone may slip from its connection at the 
elbow joint. 

Symptoms. — When the radius and ulna are both dislocated backward, 



Fig. 226. 



Fig. 227. 




ELBOW LUXATION BACKWARD. 



fig. 226, the posterior projection is very prominent. 
The olecranon process is above the external con- 
dyle, and a deep hollow may be felt on each side 
of it; while in front, under the tendons, the con- 
dyles appear like hard tumors. The hand and 
forearm are supine, and cannot be entirely turned. 
In the lateral dislocations of both bones, whether 
inward or outward, they are driven more or less 
backward. In the outward dislocation, fig. 227, 
the projection of the ulna is still greater; the co- 
ronoid process is fixed at the external condyle ; an<Jf 
the flat head of the radius forms a projection outside 
and behind the elbow, with an abrupt cavity above lateral disloca- 
it. In the inward luxation, fig. 228, the head of TI0N outward. 
the ulna is displaced behind or over the internal condyle, projecting in 




♦94 



SURGERY. 



that direction, while the external condyle is 
made equally prominent on its side by the radius 
occuyping the place of the ulna. 

When the ulna is dislocated backward, the 
olecranon can be easily felt behind the humerus ; 
the arm cannot be straightened, nor can it be 
flexed to more than a right angle ; the forearm 
and hand are also tw'sted inward. 

In dislocations of the radius forward, fig. 
229, the forearn: is more or less bent, but in 
attempting to flex it further, it is suddenly stop- 
ped before it gets to a right angle ; the elevated 
head of the radius bears against the fore part of 
the humerus, where, if a finger be pressed into 
the bend of the arm, it may be felt moving. 
The hand is also in a state of pronation. 

In the backivard dislocation of the radius, 
fig. 230, the head of the bone may be seen and 
felt behind the external condyle of the hu- 
merus ; the arm is nearly straight, and cannot 
be flexed ; the hand is pronate, and cannot be 

LATERAL DISLOCATION turned. 

inward. Treatment— The first variety is easily re- 

Fig. 229. 





FORWARD LUXATION OF THE RADIUS 
Fig. 230. 




BACKWARD LUXATION OF THE RAmut 



duced. The sur- 
geon places his 
knee on the inner 
side of the elbow, 
pressing chiefly on 
the displaced bones 
so as to keep them 
from bearing on 
the end of the hu- 



DISLOCATIONS. 395 

merus, and to bring the coronoid process out of the posterior fossa, so 
that it can pass over the condyles, while the arm is bent slowly and 
steadily with considerable force. This form of luxation can generally 
be reduced with the aid of suitable hot water relaxant processes, a long 
time after the accident. 

The second variety is mainly reduced by bending the arm over the 
surgeon's knee, as in the preceding case ; less pressure, however, is 
usually required, as the bones do not require the same separation from 
the humerus. 

The third variety is replaced still more readily by the same general 
plan. Here the bending of the arm is the principal part of the oper- 
ation, the fixed radius acting like a lever to push the humerus back into 
its place on the ulna. 

To reduce the fourth variety, the surgeon takes the patient's hand, 
as in "shaking hands," and makes steady extension, while his other 
hand is pressed strongly on the ulnar side of the head of the radius, 
pushing it outward and upward. It will facilitate the reduction to have 
the arm slightly bent. 

In the fifth variety ertcnsion is to be made upon the radius, and 
counter-extension upon the humerus, while firm pressure is made on 
the head of the bone, until it slips into its place. One assistant may 
make the extension, another the counter-extension, and the surgeon 
make the pressure and direct the movements of the bone. 

Dislocations at the Wrist. — Six varieties of luxation occur at 
this joint. The radius and ulna may together be displaced forward or 
backward, or either of them separately in either direction. 

Symptoms. — When both bones are displaced forward, their projec- 
tion is seen and felt under the carpus. This accident is caused by 
falling on the palm of the hand. When both bones are displaced back- 
ward, they project over the carpus; the carpal bones are thrown for- 




BACKWARD LUXATION AT THE WRIST. 

ward and upward under the flexor tendons, in front of the forearm. 
This lnxHtinn is represented in fig 231. These luxations ma}' bo dis- 



SURGERY. 



tinguished from sjncrins, or strains, by the more sudden occurrence 
and more uneven appearance of the swelling. 

When the radius alone is displaced, the external or thumb side of 
the hand is backward, and the opposite side inward or forward, the ex- 
tremity of the radius may also be seen to form a prominence in the 
front of the wrist. When the ulna alone is detached, which more fre- 
quently happens, the connecting ligament is necessarily ruptured; the 
hand is twisted, the bone projects at its back, from where it may be 
easily pressed down; but when the pressure is removed, the deformity 
wil reappear. 

Treatment. — The process of reduction is similar when both bones 
are displaced either forward or backward. The surgeon holds the 
hand of the patient in one of his, and with the other supports the fore- 
arm, while an assistant holds the arm at the elbow, and keeps that jokr; 
slightly flexed. When sufficient extending and counter-extending 
force is applied, the bones are drawn into place by the contraction of 
the muscles. Compresses should then be placed upon the wrist, and 
secured by a roller which should inclose the limb from the tips of the 
fingers to the elbow ; after which a splint should be added, and the fore- 
arm suspended in a sling. The same treatment precise]}' is required 
when the radius alone is dislocated. To reduce the dislocated ulna, it 
is only necessary to press the ulna down in its proper cavity at the side 
of the radius, and retain it there by compresses, bandages, and splints. 
The splinta should be well padded, extend along the forearm in a line 
with the back of the hand, and be well secured with a roller. 

Carpal and Metacarpal Dislocations. — Displacements of the 
bones of